VA 810 Vermont Ave NW Washington DC 20420 www.va.gov U.S. Department of Veterans Affairs Daniel McGrath American Oversight 1030 5th Street, NW Suite B255 Washington, DC 20005 JUN2 6 2019 Re: Freedom of Information Act Tracking Number 18-07440-F Dear Mr. McGrath, This is an interim 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, 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) 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 , 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. On May 17, 2018, you agreed to aggregate two of your request 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. I. m. n. o. • Moskowitz; Perlmutter; Ike; "Trump's friend"; "Trump's Doctor"; "POTUS friend"; "POTUS's friend"; "POTUS' friend"; "POTUS doctor"; "POTUS's doctor"; "POTUS' doctor"; "President's friend"; "friend of POTUS"; "friend of President"; or "friend of the President". 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. FOIA Request 18-07440-F (McGrath) Page 3 We are releasing fourteen hundred and one (1401) pages of responsive documents on CD at no cost to you. We are withholding information pursuant to FOIA exemption 5, [5 U.S.C. § 552 (b)(5)], which protects from disclosure all inter-agency or intra-agency memorandums or letters which would not be available by law to a party other than an agency in litigation with the agency. We are withholding thirty-seven pages (37) pages under the above exemption. FOIA exemption 6 permits an Agency to withhold from disclosure personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. The information withheld, such as names, are of a type that the privacy interest of the individual(s) to whom this information belongs outweighs any public interest in disclosure of this information. We are withholding eight hundred and eighteen (818) pages under the above exemption. We are still reviewing documents and will continue to make releases on a rolling basis until all responsive documents have been reviewed and released. 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, If ,);1{/L.>.ut-v,~~o-ras Johnson Director, VACO FOIA Service Quality, Performance, and Risk (QPR) Office of Information and Technology (OIT) Enclosed Document ID: 0.7.1705.581083 From: Cashour, Curtis Sandoval, Camilo J. Cc: Ullyot, John ; Hutton , James Bee: Subject: Date: Attachments: FW: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Tue Jul 24 2018 09:47:58 EDT Fyi below ... From: Cashour, Curtis Sent: Tues day, July 24, 2018 9:48 AM To: Isaac Arnsdorf Subject: RE: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Hi, Isaac. Please see below for VA's comment. We refer you to the Trump campaign regarding the lawsuit. Thanks . We appreciate hearing from experts both inside and outside VA as we look for better ways to serve our nation's heroes . This broad range of input from individuals both inside and outside VA has helped us immensely over the last year and a half - a period that hands-down has been VA's most productive in decades. Under President Trump's leadership, VA has made groundbreaking progress, particularly in the areas of accountability, transparency and efficiency across the department while enjoying an unprecedented series of legislative successes. We look forward to building on these improve ments as we continue to reform VA under President Trump . VA-18-0298-I-000001 Page 81 1 of 109r of 1380 Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Isaac Arnsdorf Date: Friday, July 20, 2018 at 12:44 PM To : "Camilo.Sandoval@va.gov" Subject: Ike Perlmutter , Bruce Moskowitz and Marc Sherman Hi Camilo, I'm a reporter at ProPublica, and I'm interested in talking with you about your relationship with Ike Perlmutter , Bruce Moskowitz and Marc Sherman. My questions are: 1.How do you know Ike Perlmutter? 2.Why did you move to VA from Treasury? 3.Why did you describe yourself as Perlmutter 's spy and compare yourself to Mr. Fox from Pulp Fiction? 4.Why did Jake Leinenkugel send you the Dec. 4 memo? Who did you share it with? 5.ln a March 7 emai l to Moskowitz and Sherman, you wrote, "Apparently I was supposed to share this Attachment with you last month per John's note below." The attachments were "EHRM Cerner Apple Compare _final.pptx" and "Apple App Background and Questions _final.docx ." Why were you supposed to share these documents with them? 6.How do you respond to the sexual harassment allegations against you in Jess ica Denson's lawsuit? Could you please give me a call to discuss at 203-464-1409? Thanks, Isaac VA-18-0298-I-000002 Page 812 of 109~ of 1380 Isaac Arnsdorf ProPub lica 203.464 .1409 isaac@propublica .org VA-18-0298-I-000003 Page 813 of 109~ of 1380 Document ID: 0.7.1705.580441 Sandoval, Camilo J. Cashour, Curtis ; Hutton , James Cc: Wagner , John (Wolf) ; U llyot, John Bee: Subject: FW: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Date: Mon Jul 23 2018 23:01:35 EDT Attachments: FYSA. .. I have no comment. Camilo Sandoval 202-461-6910 From: Isaac Arnsdorf [mailto:lsaac.Arnsdorf@propublica.org] Sent: Monday, July 23, 2018 10:07 AM To: Sandoval, Camilo J. Subject: [EXTERNAL] Re: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Hi Cam , just making sure you saw this . Looking forward to hearing from you . Thanks! From: Isaac Arnsdorf Date: Friday, July 20, 2018 at 12:44 PM To : "Camilo.Sandoval@va.gov" Subject: Ike Perlmutter , Bruce Moskowitz and Marc Sherman Hi Camilo, VA-18-0298-I-000004 Page 814 of 109l of 1380 I'm a reporter at ProPublica , and I'm interested in talking with you about your relationship with Ike Perlmutter , Bruce Moskowitz and Marc Sherman . My questions are: 1.How do you know Ike Perlmutter? 2.Why did you move to VA from Treasury? 3.Why did you describe yourself as Perlmutter's spy and compare yourself to Mr. Fox from Pulp Fiction? 4.Why did Jake Leinenkugel send you the Dec. 4 memo? Who did you share it with? 5.ln a March 7 email to Moskowitz and Sherman, you wrote, "Apparently I was supposed to share this Attachment with you last month per John 's note below." The attachments were "EHRM Cerner Apple Compare _final.pptx" and "Apple App Background and Questions _final.docx." Why were you supposed to share these documents with them? 6.How do you respond to the sexua l harassment allegations against you in Jessica Denson 's lawsuit? Could you please give me a call to discuss at 203-464-1409? Thanks, Isaac Isaac Arnsdorf ProPublica 203.464.1409 isaac@propublica.org VA-18-0298-I-000005 5 Page 8 15 of 109 of 1380 Document ID: 0.7.1705.578668 From: Isaac Arnsdorf To: Sandoval, Camilo J. Cc: Bee: Subject: [EXTERNAL] Re: Ike Perlmutter , Bruce Moskowitz and Marc Sherman Date: Mon Jul 23 2018 10:07 :07 EDT Attachments: Hi Cam , just making sure you saw this. Looking forward to hearing from you . Than ks! From: Isaac Arnsdorf Date: Friday, July 20, 2018 at 12:44 PM To: "Camilo.Sandoval@va.gov" Subject: Ike Perlmutter , Bruce Moskowitz and Marc Sherman Hi Camilo, I'm a reporter at ProPublica , and I'm interested in talking with you about your re lationship with Ike Perlmutter , Bruce Moskowitz and Marc Sherman. My questions are: 1.How do you know Ike Perlmutter? 2.Why did you move to VA from Treasury ? 3.Why did you describe yourself as Perl mutter's spy and compare yourself to Mr . Fox from Pulp Fiction? 4 .Why did Jake Leinenkugel send you the Dec. 4 memo? Who did you share it with? 5.ln a March 7 email to Moskowitz and Sherman, you wrote, "Apparently I was supposed to share this Attachment with you last month per John's note below ." The attachments were "EHRM Cerner Apple Compare _final.pptx" and "Apple App Background and Questions _final.docx ." Why were you supposed to share these documents with them? 6.How do you respo nd to the sexual harassment allegations against you in Jessica Denson's lawsuit? Could you please give me a call to discuss at 203-464-1409? Thanks, VA-18-0298-I-000006 Page 816 of 109~ of 1380 Isaac Isaac Arnsdorf ProPublica 203.464.1409 isaac@propublica.org VA-18-0298-I-000007 7 Page 817 of 109 of 1380 Document ID: 0.7.1705.576983 Sandoval, Camilo J. Cashour, Curtis ; Hutton , James Cc: Wagner , John (Wolf) ; U llyot, John Bee: Subject: FW: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Date: Fri Jul 20 2018 19:05: 14 EDT Attachments: FYSA. .. as usual , no comment. Camilo Sandoval 202-461-6910 From: Isaac Arnsdorf [mailto:lsaac.Arnsdorf@propublica.org] Sent: Friday, July 20, 2018 12:45 PM To: Sandoval, Camilo J. Subject: [EXTERNAL] Ike Perlmutter , Bruce Moskowitz and Marc Sherman Hi Camilo, I'm a reporter at ProPublica, and I'm interested in talking with you about your relationship with Ike Perlmutter , Bruce Moskowitz and Marc Sherman. My questions are: 1.How do you know Ike Perlmutter? 2.Why did you move to VA from Treasury? 3.Why did you describe yourself as Perlmutter 's spy and compare yourself to Mr. Fox from Pulp Fiction? VA-18-0298-I-000008 Page 818 of 109~ of 1380 4.Why did Jake Leinenkugel send you the Dec. 4 memo? Who did you share it with? 5.ln a March 7 email to Moskowitz and Sherman, you wrote, "Apparently I was supposed to share this Attachment with you last month per John's note below." The attachments were "EHRM Gerner Apple Compare _fina l.pptx" and "Apple App Background and Questions _fina l.docx." Why were you supposed to share these documents with them? 6.How do you respond to the sexual harassment allegations against you in Jessica Denson's lawsuit? Could you please give me a call to discuss at 203-464-1409? Thanks, Isaac Isaac Arnsdorf ProPublica 203.464.1409 isaac@propublica.org VA-18-0298-I-000009 Page 819 of 109~ of 1380 Document ID: 0.7.1705.576981 From: Wagner, John (Wolf) To: Sandoval, Camilo J. Cc: Bee: Subject: Automatic reply: Ike Perlmutter, Bruce Moskowitz and Marc Sherman Date: Fri Jul 20 2018 19:05:14 EDT Attachments: I am out of the office until 23 July 2018, checking emails irregularly.If it's an urgent matter please contact my office at 202-461-7500. VA-18-0298-I-000010 o~a Page 820 of 1 of 1380 Document ID: 0.7.1705.576139 From: Isaac Arnsdorf To: Sandoval, Camilo J. Cc: Bee: Subject: [EXTERNAL] Ike Perlmutter , Bruce Moskowitz and Ma rc Sherman Date: Fri Jul 20 2018 12:44:47 EDT Attachments: Hi Camilo, I'm a reporter at ProPublica , and I'm interested in talking with you about your relationship with Ike Perlmutter , Bruce Moskowitz and Marc Sherman. My questions are: 1.How do you know Ike Perlmutter? 2.Why did you move to VA from Treasury? 3.Why did you desc ribe yourself as Perlmutter 's spy and compare yourself to Mr. Fox from Pulp Fiction? 4 .Why did Jake Leinenkuge l send you the Dec. 4 memo? Who did you share it with? 5.ln a March 7 email to Moskowitz and Sherman, you wrote, "Apparently I was supposed to share this Attachment with you last month per John 's note below." The attachments were "EHRM Cerner Apple Compare _final.pptx " and "Apple App Background and Questions _final.docx ." Why were you supposed to share these documents with them? 6 .How do you respond to the sexual harassment allegations against you in Jessica Denson's lawsuit? Could you please give me a call to discuss at 203-464-1409? Thanks, Isaac Isaac Arnsdorf ProPub lica 203.464 .1409 isaac@propublica .org VA-18-0298-I-000011 O~r Page 82 1 of 1 of 1380 Document ID: 0.7.1705.570660 From: Sandoval, Camilo J. To: Cashour, Curtis ; Ullyot , John ; Hutton , James Cc: Bee: RE: Ike Perlmutter, Marc Sherman and Bruce Moskowitz Subject: Tue Jul 17 2018 10:27:19 EDT Date: Attachments: Thank you Camilo Sandoval 202-461-6910 From: Cashour, Curtis Sent: Tuesday , July 17, 2018 10:25 AM To : Ullyot, John; Hutton , James; Sandoval , Camilo J. Subject: FW: Ike Perlmutter, Marc Sherman and Bruce Moskowitz Fyi below ... Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour VA-18-0298-I-000012 Page 823 of 1o~~ of 1380 From: Isaac Arnsdorf [ma ilto:lsaac .Arnsdorf@propubl ica .org] Sent: Tuesday , July 17, 2018 9:31 AM To : Cashour, Curt is Subject: [EXTERNAL] Ike Perlmutter , Marc Sherman and Bruce Moskowitz Hi Curt, I'm writing an article about the influence of Ike Perlmutter , Marc She rman and Bruce Moskowitz over the Department of Veterans Affairs. The story will describe how, despite having no official role and no relevant expertise , these three men have unprecedented authority over the VA. Here are my specific quest ions: 1.Why do Perlmutter , Sherman and Moskow itz advise VA officials ? 2.What is their relevant experience or expert ise? 3.Why doesn 't the agency use the advisory mechanism provided under FACA? 4.Why don't these advisers abide by the same oversight and ethical standards as government employees? 5.What is the total cost in taxpayer dollars of officia ls' trave l to Mar-a-Lago to meet with Perlmutter, Sherman and Moskowitz? 6.Were these trips approved by counsel? Please provide documentat ion. ?.Why did Robert Wilkie meet with Marc Sherman on April 2? What did they discuss? 8.Why did Robert Wilkie and Peter O'Rourke trave l to Mar-a-Lago on April 20? What ethics counse l approved this trip? What did they discuss with Perlmutter , Moskow itz and Sherman? 9.On or about March 4, 2017 , Shulkin called Perlmutter and Moskowitz to rev iew an agenda before presenting it to the President. What was on this agenda and why did he need to review it with Perlmutter and Moskowitz first? 10.On Feb. 28, March 31 , and April 17, 2017, Perlmutter convened conference calls with sen ior officials from Johnson & Johnson . I understand these discussions were related to the #Be There campaig n, leading to Dr. Shu lkin's ringing the closing bell at the New York Stock Exchange with Marve l, Disney and Johnson & Johnson on Nov. 7, 2017 . Why were Marve l and Disney included even though the campaign involved only Johnson & Johnson? 11.On Nov . 7, 2017 , Secretary Shu lkin stood on the platform at the New York Stock Exchange next to Captain Ame rica . How does this comply with 5 CFR 2635 .702(c)? 12.ln an Oct. 20 , 2017 , a VA official asked ethics counsel about the NYSE event, raising Shu lkin 's relationsh ip with Perlmutter as a possible concern. Did the ethics counsel app rove the event , and what explanation did he or she provide? 13.What will be the role of Bruce Moskowitz , Aaron Moskowitz, and/or the Biomedical Research and Educat ion Foundat ion in the implementat ion of the VA 's new medical device registry? 14.What was the cost of the Med ical Device Registry Summit? 15.Why does Cam ilo Sandoval describe himself as Perlmutter 's spy and compare himself with Mr. Fox from "Pulp Fiction"? What is his relationship with Perlmutter and Jared Kushner? 16.Why did Sandoval move to VA from Treasury? 17.What is Sandoval 's response to the sexua l harassment allega tions against him? 18.Who asked Jake Leinenkugel to prepare the Dec. 4 memo to Sandoval? Who did Sandoval sha re the memo with? 19.On Sept. 18, 2017 , in an email to VA officials, Perlmutter wrote: "We have been talking to Dr. Shu Ikin for many months about ident ifying the existence of healt hcare delivery issues at VA medical cente rs ... [W]e think that some of the VA hospitals are del iver ing some specialty hea lthcare when they VA-18-0298-I-000013 Page 824 of 1o~~ of 1380 shouldn 't and when referrals to private facilities or other VA centers would be a better option .. . Our solution is to make use of academ ic medical centers and medica l trade groups , both of whom have offered to send review teams to the VA hospitals to help this effort. " What became of this proposal? 20.1understand the VA was planning to engage the American College of Surgeons to analyze the quality of VA 's surg ical programs , at the suggestion of Dr. Moskow itz . How much would this cost the VA? Why wasn 't the collaboration finalized? 21.Why did the VA consider work ing with Apple to deve lop an app by Dr. Moskowitz's son? Why didn't the project proceed? 22.ln a March 7 email to Dr. Moskowitz and Mr. Sherman, Mr. Sandoval wrote, "Apparently I was supposed to share this Attachment with you last month per John's note below ." The attachments were "EHRM Gerner Apple Compare _final.pptx " and "Apple App Background and Questions _final.docx." Why was Sandoval supposed to share these documents with Moskowitz and Sherman? 23.How did VA officials address the concerns about the Gerner contract raised by Perlmutter , Moskowitz and Sherman? 24.After Gerner accepted all the recommendations from the Mitre report , why did it still take months to sign the Gerner contract? 25.What changed about the Gerner contract between when Perlmutter , Moskow itz and Sherman didn' t want Shulkin to sign it in March , and when Wilkie signed it in May? 26.ln a Feb. 28 email, why did O'Rourke give Perlmutter , Moskowitz and Sherman his personal contact information? Has he been conducting official business on his personal email? How is VA ensuring his compliance with the Federal Records Act? 27.What was the mental health "emergency 'committee '" that Moskow itz wrote about in a Feb. 28 email to O'Rourke and Shulk in? Why did O'Rourke reply, "I will begin a project plan and develop a timel ine for action "? 28.Once confirmed , will Wilkie assert his own authority over the VA or take direction from Perlmutter , Sherman and Moskowitz? Thanks , Isaac Isaac Arnsdorf ProPublica 203.464 .1409 isaac@propublica .org VA-18-0298-I-000014 O~lof 1380 Page 825 of 1 Document ID: 0.7.1705.570594 Cashour, Curtis Ullyot , John ; Hutton , James ; Sandoval , Camilo J. Cc: Bee: Subject: FW: Ike Perlmutter, Marc Sherman and Bruce Moskowitz Date: Tue Jul 17 2018 10:24:51 EDT Attachments: Fyi below ... Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Isaac Arnsdorf [mailto:lsaac.Arnsdorf@propublica.org] Sent: Tuesday , July 17, 2018 9:31 AM To: Cashour, Curtis Subject: [EXTERNAL] Ike Perlmutter , Marc Sherman and Bruce Moskowitz Hi Curt, I'm writing an article about the influence of Ike Perlmutter , Marc Sherman and Bruce Moskowitz over the Department of Veterans Affairs. The story will describe how, despite having no official role and no relevant expertise , these three men have unprecedented authority over the VA. Here are my specific questions: VA-18-0298-I-000015 Page 826 of 1o~ of 5 1380 1.Why do Perlmutter , Sherman and Moskowitz advise VA officials? 2.What is their relevant experience or expertise? 3.Why doesn't the agency use the adv isory mechanism provided under FACA? 4.Why don 't these advisers abide by the same oversight and ethical standards as government employees? 5.What is the total cost in taxpayer dollars of officials' trave l to Mar-a-Lago to meet with Perlmutter , Sherman and Moskowitz? 6.Were these trips approved by counsel? Please provide documentation. 7.Why did Robert Wilkie meet with Marc Sherman on April 2? What did they discuss? 8.Why did Robert Wilkie and Peter O'Rourke travel to Mar-a-Lago on April 20? What ethics counsel approved this trip? What did they discuss with Perlmutter, Moskowitz and Sherman? 9.On or about March 4, 2017 , Shulkin called Perlmutter and Moskowitz to review an agenda before presenting it to the President. What was on this agenda and why did he need to review it with Perlmutter and Moskowitz first? 10.On Feb. 28, March 31, and April 17, 2017, Perlmutter convened conference calls with senior officials from Johnson & Johnson. I understand these discussions were related to the #BeThere campaign, leading to Dr. Shulkin's ringing the closing bell at the New York Stock Exchange with Marvel, Disney and Johnson & Johnson on Nov. 7, 2017. Why were Marvel and Disney included even though the campaign involved only Johnson & Johnson? 11.On Nov . 7, 2017 , Secretary Shulkin stood on the platform at the New York Stock Exchange next to Captain America. How does this comply with 5 CFR 2635 .702(c)? 12.ln an Oct. 20, 2017 , a VA official asked ethics counsel about the NYSE event, raising Shulkin's relationship with Perlmutter as a possible concern. Did the ethics counsel approve the event , and what explanation did he or she provide? 13.What will be the role of Bruce Moskowitz, Aaron Moskowitz, and/or the Biomedical Research and Education Foundation in the implementation of the VA 's new medical device registry? 14.What was the cost of the Med ical Device Registry Summit? 15.Why does Camilo Sandoval describe himself as Perlmut ter's spy and compare himself with Mr. Fox from "Pulp Fiction"? What is his relationship with Perlmutter and Jared Kushner? 16.Why did Sandoval move to VA from Treasury? 17.What is Sandoval 's response to the sexual harassment allegations against him? 18.Who asked Jake Leinenkugel to prepare the Dec. 4 memo to Sandoval? Who did Sandoval sha re the memo with? 19.On Sept. 18, 2017 , in an email to VA officials, Perlmutter wrote: "We have been talking to Dr. Shulkin for many months about identifying the existence of healthcare delivery issues at VA medical centers ... [W]e think that some of the VA hospitals are delivering some specialty hea lthcare when they shouldn 't and when referrals to private facil ities or other VA centers would be a better option ... Our solution is to make use of academic medical centers and medical trade groups, both of whom have offered to send review teams to the VA hospitals to help this effort." What became of this proposal? 20.1 understand the VA was planning to engage the American College of Surgeons to analyze the quality of VA 's surgical programs , at the suggestion of Dr. Moskowitz. How much would this cost the VA? Why wasn 't the collaboration fina lized? 21 .Why did the VA consider working with Apple to develop an app by Dr. Moskowitz's son? Why didn 't the project proceed? 22.ln a March 7 email to Dr. Moskowitz and Mr. Sherman, Mr. Sandoval wrote, "Apparently I was supposed to share this Attachment with you last month per John 's note below." The attachments were "EHRM Gerner Apple Compare _final.pptx" and "Apple App Background and Questions _final.docx." Why was Sandoval supposed to share these documents with Moskowitz and Sherman? 23 .How did VA officials address the concerns about the Gerner contract raised by Perlmutter , Moskowitz and Sherman? 24.After Gerner accepted all the recommendations from the Mitre report, why did it still take months to sign the Gerner contract? 25.What changed about the Gerner contract between when Perlmutter , Moskowitz and Sherman didn't want Shulkin to sign it in March , and when Wilkie signed it in May? 26 .ln a Feb. 28 email, why did O'Rourke give Perlmutter , Moskowitz and Sherman his personal contact VA-18-0298-I-000016 Page 827 of 1o~~ of 1380 information? Has he been conducting official business on his personal email? How is VA ensuring his compliance with the Federal Records Act? 27.What was the mental health "emergency 'committee' " that Moskow itz wrote about in a Feb. 28 email to O'Rourke and Shulk in? Why did O'Rourke reply, "I will begin a project plan and develop a timeline for action "? 28.0nce confirmed , will Wilkie assert his own authority over the VA or take direction from Perlmutter , Sherman and Moskowitz? Thanks, Isaac Isaac Arnsdorf ProPublica 203.464.1409 isaac@propublica .org VA-18-0298-I-000017 Page 828 of 1o~ of 7 1380 Document ID: 0.7.1705.556276 From: Windom, John H. l(b)(6) l; Morris, Genevieve (OS/ONC/IO) (b)(6) hhs.gov> ; Sandoval, Camilo J. Cc: Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 2018 10: 18:56 EDT image001.png Sounds great. I can on you folks to massage as appropriate. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile:l._ (b_)(5_l ___ ___. 6l__ Executive Assistant: MsJ._ (b_)(_ 6l__ ,__l (b_)(_ _.l - Appointments and Scheduling ~l@va.gov Office: 202-382-3792 From:,__l (b_)(_s)______ ~ VA-18-0298-I-000018 o~iof 1380 Page 829 of 1 Sent Thu rsday, June 28, 2018 9:41 AM To: Windom, John H.; Morris, Genevieve (OS/ONC/IO); Sandoval, Camilo J. Subject: RE: OEHRM John , we will go with something more akin to what USO Wilkie would have said in the hearing (this group of QFRs is different as it would have been actually asked in the hearing): (pretty close to wha t you wrote, just less detail) As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized dozens of external executives and technical/clinical subject matter experts throughout the health care industry and had them sign VA Non-Disclosure Agreements . Dr. Moskowitz was one of those experts . Kindly ,j(b)(6) l(b_)(_6)_____ .... 6)_____ Emaid.... (b_)(_ _.l t Special Assistant/ OCLA / Department of Veterans Affairs ~ @va.gov I Phone: 202-461-6434 / Mobile: l~ (b-)(G_ )____ ~ 810 Vermont Ave/ Washington, D.C , NW 20420 From: Windom, John H. Sent Thursday, June 28, 2018 8:34 AM To: Morris , Genevieve (OS/ONC/IO) !~ (b-)(-6)____ ___,@hhs.gov> ; l(b)(6) l(b)(6) @va.gov>; Sandoval , Camilo J. ----------~ Subject: RE: OEHRM Do you want to hold or offer the entire list? JW VA-18-0298-I-000019 o~iof 1380 Page 830 of 1 John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va .gov Office: (202) 461-5820 6 (b_J(_ l____ Mobile: 1..... _, Executive Assistant: Ms ..... l(b_)(_6 l__ 5 ._l (b-)( _) _.l - Appointments and Scheduling _....,l @va.gov Office: 202-382-3792 From: Morris , Genevieve (OS/ONC/IO (b)(S) Sent: Thursday, June ~,..._ _______ To: Windom, John H.; (b)(6) __. Cc: Sandoval, Camilo ~ . _______ Subject: [EXTERNAL) Re: OEHRM __, hhs.gov] I'm good with the below. On: 28 June 2018 08:28 , "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference. Vr John VA-18-0298-I-000020 o~iof 1380 Page 831 of 1 A) Electronic Health Record Modern ization EHR modern ization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records- requires input from specialized profess ionals to align the VA and U.S. Department of Defense with an interoperable system . During our meet ing, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Gerner. Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? * As part of VA's overa ll due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external execut ives and technica l/cl inical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requis ite VA Non-Disclos ure Agreement as did each of the other participants. John H. Windom , Senior Executive Service (SES) Program Executive for Electronic Health Record Modern ization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va .gov Office : (202) 461-5820 Mobile ~.__ (b_)(_ G)____ _. Executive Assistant: Ms. ~l (b-)(-G)--~I 6)__ l.__ (b_)(_ - Appointments and Scheduling _,l@va.gov Office : 202-382-3792 I From: l(b)(G) Sent: Wednesday , June 27, 2018 6:59 PM To: Ullyot , John; Cashour , Curtis ; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; VA-18-0298-I-000021 Page 832 of 1o~ of 1 1380 Fiotes, Stella S. (CFM) ; Shelby , Peter J.; Morris, Genev ieve (OS/ONC/1O); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson , Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders , please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH . Need them NLT COB tomorrow , sooner if possible. A-OP IA/Traci B, C-VHA/CFM 0 -OEHRM E-HR&A F-Traci/OPIA Sent with Good (www .good .com) VA-18-0298-I-000022 Page 833 of 1o~~ of 1380 Document ID: 0.7.1705.556277 Windom, John H. To: Morris, Genevieve (OS/ONC/IO,.... )~-----~ !(b)(6) ~ hhs.gov>; ._l (b_)(6 _)_____ ~ Sandoval, Camilo J. Bee: RE: OEHRM Subject: Thu Jun 28 2018 10:17:42 EDT Date: image001.png Attachments: image002.png OK here. Thx John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile:.... l(b_)(_G)____ ~ 6 Executive Assistant: Ms ..... l(b_l(_l__ 6 l._ (b_)( _l_ __,~va.gov _.~Appointments and Scheduling Office: 202-382-3792 VA-18-0298-I-000023 Page 836 of 1o~~ of 1380 From: Morris, Genevieve (OS/ONC/I0) ..,..1 (b_)(_ 6)______ Sent: Thu rsday, June 28 1 2018 9:11 AM Windom, John H. To: l(b)(6) Cc: Sandoval, Camilo J. Subject: [EXTERNAL] RE: OEHRM ~ @hhs.gov] I That's fine. There's no need to give a specific number really. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) ~l (b_ )(6_) --~l (m) www .healthit.gov I Health IT Buzz Blog I @ONC_HealthlT From: l(b)(G) ~va.gov> Sent: Thu rsday, June 28, 2018 9:10 AM (b-)(-6)----...... !g]hhs.gov> ; Windom , John H. Cc: Sandoval , Camilo J. Subject: RE: OEHRM Can we say : As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized dozens of external executives and technical/clinical subject matter experts throughout the health care industry and had them sign VA Non-D isclosure Agreements . Dr. Moskowitz was one of those experts. VA-18-0298-I-000024 Page 837 of 1o~~ of 1380 Kindly ,l(b)(6) 6 ~l (b_)(_)_____ ~1 I Special Assistant / OCLA / Depa rtment of Veterans Affairs Email: ._l (b_)(_ 6)_____ _,t@va.gov / Phone: 202-461-6434 / Mobile: ._l (b_)(6 _)___ 810 Vermont Ave/ Washington, __. D.C , NW 20420 From: Morris, Genevieve (OS/ONC/ IO~.... (lb _)(_6)_______ __. @hhs.gov] Sent: Thursday, June 28 , 2018 8:32 Ar01 (b_)(_6l_____________ To: Windom, John H.; ~l Cc: Sandoval, Camilo J. Subject: [EXTERNAL] Re: OEHRM ~ @va.go v> I'm good with the below. On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers . However, it is attached for easy reference . Vr John A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense VA-18-0298-I-000025 Page 838 of 1o~~ of 1380 with an interoperable system . During our meeting, you mentioned that you consu lted with experts and approp riate parities prior to moving forward with the VA's contrac t with Cerner. * Who specifically did you seek input from on th is contract? Did Dr. Bruce Moskowitz or any othe r individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents , the EHRM Team utilized 50 external execut ives and technica l/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requis ite VA Non-Disclos ure Agreement as did each of the other participants. John H. Windom , Senior Executive Service (SES) Program Executive for Electronic Health Record Modern ization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office : (202) 461-5820 6>___ Mobile :~l (b_)(_ ~ Executive Assistant: Ms. ~l (b_)(S _)_ l~ (b_)(6 _>_ __,~va.gov __.I - Appointments and Scheduling Office : 202-382-3792 From:~l (b_)(_6)______ ~ Sent: Wednesday , June 27, 2018 6:59 PM To : Ullyot , John; Cashour, Curtis ; Hutton, James ; Nicholas, Kirk ; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S. (CFM) ; Shelby, Peter J.; Morris, Genev ieve (OS/ONC/IO); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson , Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: VA-18-0298-I-000026 o~iof 1380 Page 839 of 1 Leaders, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, sooner if possible . A-OP IA/Traci 8, C-VHA/CFM 0-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www .good.com) VA-18-0298-I-000027 Page 840 of 1o~ of 7 1380 Document ID: 0.7.1705.556260 From: ..... l(b _)(_6)______ ~l To: Windom, John H. ; Morris, Genevieve (OS/ONC/IO) l(b)(6) !@hhs.gov>; Sandoval, Camilo J. Cc: Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 2018 09:40:50 EDT image001.png John , we will go with something more akin to what USO Wilkie would have said in the hearing (this group of QFRs is different as it would have been actually asked in the hearing): (pretty close to what you wrote, just less detail) As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized dozens of external executives and technical/clinical subject matte r experts throughout the health care industry and had them sign VA Non-Disclosure Agreements. Dr. Moskowitz was one of those experts. Kind ly ,l(b)(6) ..... l(b _)(_6l____ ___,l 1Special Assistant/ Email: ~l (b_)(6_) ____ OCLA / Department of Veterans Affairs ___,l @va.gov / Phone: 202-461 -6434 / Mobile: j~ (b_)(6_) __ ~ 810 Vermont Ave/ Washington, D.C , NW 20420 VA-18-0298-I-000028 o~iof 1380 Page 845 of 1 From: Windom, John H. Sent: Thursday, June 28, 2018 8:34 A ,-"-'M'----------. To: Morris, Genevieve (OS/ONC/IO) l(b)(G) @hhs.gov> ;l(b)(6) l(b)(6) @va.gov> ; Sandoval , Camilo J. ----------~ Subject: RE: OEHRM Do you want to hold or offer the entire list? JW John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va.gov Office: (202) 461-5820 (b_)(6 _)___ Mobile: l~ ~ Executive Assistant: Ms.~l (b_)(G _)_~I 6 _ ___, l..... (b_)(_> ~va.gov - Appointments and Scheduling Office: 202-382-3792 (b_)(G _)______ From: Morris, Genevieve (OS/ONC/IO) ~l Sent: Thursday , June 28, 2018 8:32 AM To: Windom, John H.; Haverstock, Cathleen Cc: Sandoval, Camilo J. Subject: [EXTERNAL] Re: OEHRM ~ @hhs.gov] I'm good with the below. VA-18-0298-I-000029 o~iof 1380 Page 846 of 1 On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference. Vr John A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professiona ls to align the VA and U.S. Department of Defense with an interoperable system . During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Gerner. * Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents , the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclos ure Agreement as did each of the other participants. John H. Windom , Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile:..... l(b_)(6 _)____ _. Executive Assistant: Ms. l~ (b_)(6 _)_~I l~ (b_)(6 _)_~l - Appointments and Scheduling @va.gov Office: 202-382-3792 VA-18-0298-I-000030 Page 84 7 of 1 o~iof 1380 From:~l (b_)(G_ )______ ~ Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot, John; Cashour , Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S. (CFM); Shelby, Peter J.; Morris, Genevieve (OS/ONC/ IO); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson , Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders , please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, sooner if possible . A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Trac i/OPIA Sent with Good (www.good.com) VA-18-0298-I-000031 Page 848 of 1o~ of 1 1380 Document ID: 0.7.1705.556259 Morris, Genevieve (OS/ONC/ IO) From: ljb)(6) e)hhs.gov> Sandoval, Camilo J. Bee: [EXTERNAL] RE: OEHRM Subject: Thu Jun 28 2018 09:36:27 EDT Date: image002 .png Attachments: image003 .png I Correct, we don't need to say 50 and shouldn't offer the list right now. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) l(b)(G) l(m) www.healthit.gov I Health IT Buzz Blog I @ONC_HealthlT Froml(b)(G) l@va.gov> Sent: Thursday, June 28, 2018 9:12 ~A_M_____ ~ To: Morris, Genevieve (OS/ONC/IO ~(b)(6) l@hhs.gov> Cc: Sandoval, Camilo J. Subject: RE: OEHRM I didn't see it at first, sorry ... but not sure we need to say 50? Definitely no list until we are asked outright? VA-18-0298-I-000032 Page 851 of 1o~~ of 1380 Kindly, l(b)(G) ~l (b_)(_G)____ ~I/ Special Assistant/ Email: ~l (b_)(_ G)_____ OCLA / Department of Veterans Affairs ~ @va .gov / Phone: 202-461-6434 / Mobile: l._ (b_)(G _l ___ __, 810 Vermont Ave/ Washington, D.C , NW 20420 From: Morris, Genevieve (OS/ONC/10 J.... (b_)(_6 )______ Sent: Thursday, June 28, 2018 9:10 AM To: l(b)(G) @va.gov> Cc: Sandoval, Camilo J. Subject: [EXTERNAL] RE: OEHRM ~ @hhs.gov] It might have gotten buried, but here's what we have. Is it not sufficient? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services VA-18-0298-I-000033 Page 852 of 1o~~ of 1380 (202) 774-3080 (o) l_(G)__ .__l (b ____.I (m) www .healthit.gov I Health IT Buzz Blog I @ONC_ Health lT From: l(b)(6) @va.gov> Sent: Thursday, June 28, 2018 9:04 ;-c A=M~------, To: Morris, Genev ieve (OS/ONC/IO) l(b)(6) @hhs.gov> Cc : Sandoval, Camilo J. Subject: RE: OEHRM Definitely agree that we aren 't giving them a list. Need an answer as it would have been in the hear ing ...Genev ieve , can you take a stab at that? Thanks! Kind ly ,l(b)(G) ~l (b_)(_ G)____ ~I;Specia l Ass istant/ Email: ..... l(b_)(_6l_____ OCLA / Department of Veterans Affairs __, ~ va.gov / Phone: 202-461 -6434 / Mobile~~ (b_)(G _)___ ~ 81 O Vermont Ave/ Washington , D.C , NW 20420 From: W indom , John H. Sent: Thursda y, June 28, 2018 8:26 AM To: l(b)(6) @va.gov> Cc : Sandoval, Camilo J. ; 'Mor ris, Genev ieve (OS/ONC/10)' ._l (b_)(_6)___ l(b)(6) @hhs.gov> Subject: FW: OEHRM ~ VA-18-0298-I-000034 Page 853 of 1o~~ of 1380 Importance: High l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr John A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system . During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. ******** Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile:~l (b_)(6_l ___ ~ 6 Executive Assistant: Ms ..... l(b_)(_ l__ 6 .... 1 (b-)(_l__ l- ......Appointments and Scheduling ...... ~va .gov Office: 202-382-3792 VA-18-0298-I-000035 Page 854 of 1o~~ of 1380 From: ..... l(b_)(_ s )_____ ____. Sent: Wednesday , June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James; Nicholas, Kirk; Jensen , Jon M.; Clancy , Carolyn; Fiotes, Stella S. (CFM) ; Shelby, Peter J. ; Morris, Genevieve (OS/ONC/IO) ; Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders , please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NL T COB tomorrow , sooner if possible. A-OP IA/Traci B, C-VHA/CFM 0-OEHRM E-HR&A F-Trac i/OPIA Sent with Good (www.good .com) VA-18-0298-I-000036 o~iof 1380 Page 855 of 1 Document ID: 0.7.1705.556249 From: !(b_)(G ,_ _)_____ ~l Morris, Genevieve (OS/ONC/IO) To: l(b)(6) @hhs .gov> Sandoval, Camilo J . Bee: RE: OEHRM Subject: Thu Jun 28 2018 09: 12:03 EDT Date: image001 .png Attachments: image002 .png I didn't see it at first, sorry ... but not sure we need to say 50? Definitely no list until we are asked outright? Kindly, l(b)(6) ._l (b_)(6 _)____ .....,I / Special Assistant/ OCLA / Department of Veterans Affairs Email: ..... l(b_)(_6)_____ _.@va.gov / Phone: 202-461-6434 / Mobile: ._l (b_)(6 _)___ _. 810 Vermont Ave/ Washington, D.C , NW 20420 From: Morris, Genevieve (OS/ONC/IO) ._l (b_)(_6)______ Sent: Thu rsday, June 28, 2018 9:10 AM To:l(b)(6) @va.gov> Cc: Sandoval, Camilo J. Subject: [EXTERNAL] RE: OEHRM ____. ~hhs .gov] It might have gotten buried, but here's what we have. Is it not sufficient? VA-18-0298-I-000037 Page 860 of 10~1' of 1380 As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) (b)(6) ~----~ l I www.healthit.gov (m) I Health IT Buzz Blog I @ONC_HealthlT From :l(b)(G) @va .gov> Sent: Thursday, June 28, 2018 9:04 AM To: Morris, Genevieve (OS/ONC/IO) ~ !(b-)(-6)----~ @hhs.gov> Cc: Sandoval , Camilo J. Subject: RE: OEHRM Definitely agree that we aren't giving them a list. Need an answer as it would have been in the hearing ... Genevieve , can you take a stab at that? Thanks! VA-18-0298-I-000038 o~iof 1380 Page 861 of 1 Kindly, ~ ~' (b_)(_6)_____ ~ifSpecial Assistant/ Email: ~l (b_)(_ 6)_____ OCLA / Department of Veterans Affairs ~~va .gov / Phone: 202-461-6434 / Mobile: ~l (b-)(6 - )---~ 810 Vermont Ave/ Washington, D.C , NW 20420 From: Windom, John H. Sent: Thursday, June 28, 2018 8:26 AM To :l(b)(6) !tq?va.gov> Cc: Sandoval, Camilo J.; 'Morris, Genevieve (OS/ONC/IO)' l(b)(6) l(b)(6) @hhs .gov> ~---~ Subject: FW: OEHRM Importance : High l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts . I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr John A.Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system. During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. *Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. VA-18-0298-I-000039 o~iof 1380 Page 862 of 1 John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile: .... l(~_)(S _)~, ---~ l(b)(6) Executive Assistant: Ms. ~---~ l(b)(6) ~---~ I@va .gov J !- Appointments and Scheduling Office: 202-382-3792 From:~l (b_)(_ S)_____ ~ Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S. (CFM) ; Shelby, Peter J.; Morris, Genevieve (OS/ONC/1O); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow , sooner if possible . A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good .com) VA-18-0298-I-000040 oiiof 1380 Page 863 of 1 Document ID: 0.7.1705.556247 Morris , Genevieve (OS/ONC/ IO) From: ~ (6) @ hhs.gov> (b)(6) l; Windom, John H. Cc: Sandoval, Camilo J. Bee: Subject: [EXTERNAL] RE: OEHRM Date: Thu Jun 28 2018 09:10:51 EDT Attachments: image002.png image003 .png That's fine . There's no need to give a specific number really . Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) l(b_ ..... )(6_ ) __ _____.I (m) www.healthit.gov I Health IT Buzz Blog I @ONC_HealthlT From:l(b)(6) l@va.gov> Sent: Th ursday, June 28, 2018 9:10 A ,_M _____ __, To: Morris, Genevieve (OS/ONC/1O) l(b)(6) @hhs .gov>; Windom , John H. Cc: Sandoval, Camilo J. Subject: RE: OEHRM Can we say: VA-18-0298-I-000041 oi1of 1380 Page 869 of 1 As part of VA 's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents , the EHRM Team utilized dozens of external executives and technical/clinical subject matter experts throughout the health care industry and had them sign VA Non-D isclosure Agreements . Dr. Moskow itz was one of those experts. Kindly , ~ 6)____ l(b_)(_ .... lt ..... Special Assistant/ OCLA / Department of Veterans Affairs 6)_____ Email:-l(b_)(_ ~l@va.gov / Phone: 202-461-6434 / Mobile: -l(b_)(G _) __ ~ 81 0 Vermont Ave / Washington , D.C , NW 20420 _)_______ ka)hhs.gov] From: Morr is, Genevieve (OS/ONC/IO) -l(b_)(6 Sent: Thursday , June 28 , 2018 8:32 AM To: Windom, John H.; l(b)(6) .g_o_v.,..... >_____________ Cc: Sandoval , Cam ilo J. __. Subject: [EXTERNAL] Re: OEHRM I'm good with the below. On : 28 June 2018 08:28 , "Windom, John H." wrote: Cathleen , Subject to review by Genevieve and Camilo , here are my thoughts . I defer to them as to whether we VA-18-0298-I-000042 oi~of 1380 Page 870 of 1 provide the entire list of external reviewers. However, it is attached for easy reference . Vr John A) Electronic Health Record Modern ization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system . During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. * Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclos ure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John .Windom@va.gov Office: (202) 461-5820 6 Mobile ~._ (b-)(_)____ _. Executive Assistant: Ms. ~l (b-)(-6 6 ._l (b_)(_ )_ )--~I- Appointments and Scheduling _.l @va .gov Office : 202-382-3792 VA-18-0298-I-000043 oi~of 1380 Page 871 of 1 From: ... l(b_)(_G )______ _. Sent: Wednesday , June 27, 2018 6:59 PM To: Ullyot, John; Cashour , Curtis ; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S. (CFM); Shelby , Peter J.; Morris, Genevieve (OS/ONC/1O); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor , Christopher; Anderson , Christopher; Powers , Pamela J SES OSD OUSD P-R (US) Subject: Leaders, please task these out ASAP . We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH . Need them NLT COB tomorrow , sooner if possible. A-OPINTraci B, C-VHNCFM 0-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www .good .com) VA-18-0298-I-000044 oi~of 1380 Page 872 of 1 Document ID: 0.7.1705.556245 Morris, Genevieve (OS/ONC/ IO) From: j(b)(G) @ hhs.gov> To: l(b)(G) l Sandoval, Camilo J. Bee: [EXTERNAL] RE: OEHRM Subject: Thu Jun 28 2018 09:09:53 EDT Date: image002 .png Attachments: image003 .png It might have gotten buried, but here's what we have. Is it not sufficient? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclos ure Agreement as did each of the other participants. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) ~l (b)_(G)__ ~l (m) www.healthit.gov I Health IT Buzz Blog I @ONC_HealthlT From:~l (b_)(_6 )_____________ Sent: Thursday , June 28, 2018 9:04 AM ~ @va.gov> VA-18-0298-I-000045 oi~of 1380 Page 877 of 1 To: Morris, Genevieve (OS/ONC/IO) l(b)(G) Cc: Sandoval, Camilo J. Subject: RE: OEHRM @hhs .gov> Definitely agree that we aren't giving them a list. Need an answer as it would have been in the hearing ... Genevieve, can you take a stab at that? Thanks! Kindly, ~ ~l (b_)(_G )____ ~ VSpecial Assistant/ Email: ~l (b_)(6 _J____ OCLA / Department of Veterans Affairs ~l @va.gov / Phone: 202-461-6434 / Mobile: ~l (b_J(G _J___ ~ 810 Vermont Ave/ Washington , D.C , NW 20420 From: Windom, John H. Sent: Thursday, June 28, 2018 8:26 AM To:l(b)(G) l52va.gov> Cc: Sandoval , Camilo J. ; 'Morris, Genevieve (OS/ONC/IO)' l(b)(G) l(b)(G) @hhs.gov > ~---Subject: FW: OEHRM Importance : High l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr John VA-18-0298-I-000046 oiiof 1380 Page 878 of 1 A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system . During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Gerner. ******** Who specif ically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individua l outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing var ious aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents , the EHRM Team utilized 50 externa l executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. John H . Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office : (202) 461-5820 Mobile :.... l(b_)(6 _>___ ___, Executive Assistant: Ms. l.(b-)(-G )---,I 1~ (b_)(6_>_~l - Appointments and Schedu ling @va.gov Office : 202-382-3792 I Froml(b)(6) Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S . (CFM) ; Shelby , Peter J.; Morris, Genevieve (OS/ONC/ IO); Windom , John H.; Scott, VA-18-0298-I-000047 oi1'of 1380 Page 879 of 1 Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, sooner if possible . A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good .com) VA-18-0298-I-000048 Page 880 of 10j~ of 1380 Document ID: 0.7.1705.556241 6)______ From: ...._)(_ l(b ....,l To: Morris, Genevieve (OS/ONC/IO) l(b)(6) @hhs.gov> ; Windom, John H. Cc: Sandoval, Camilo J. Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 2018 09:09:31 EDT image001.png Can we say : As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents , the EHRM Team utilized dozens of external executives and technical/clinical subject matter experts throughout the health care industry and had them sign VA Non-Disclosure Agreements . Dr. Moskowitz was one of those experts. Kindly, l(b)(G) 6 l(b-)(_l____ .... ~jfSpecial Assistant/ Emai1:.... l(b_)(_ 6J_____ OCLA / Department of Veterans Affairs 5 _.t@va.gov / Phone: 202-461-6434 / Mobile: l._ (b_)(_l ___ 810 Vermont Ave/ Washington, _. D.C , NW 20420 6l______ From: Morris, Genevieve (OS/ONC/10) ..,..1 (b_)(_ Sent: Thursday, June 28 , 2018 8:32 AM _. @hhs.gov] VA-18-0298-I-000049 oiiof 1380 Page 885 of 1 To: Windom, John H. l~ (b_)(_6l_____________ Cc: Sandoval , Cam ilo J. Subject: [EXTERNAL] Re: OEHRM ~l @va.gov> I'm good with the below. On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers . However , it is attached for easy reference . Vr John A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system. During our meeting , you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. * Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants . John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modern ization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) VA-18-0298-I-000050 Page 886 of 10~ of 1380 Washington , DC 20420 John.Windom@va.gov Office: (202) 461-5820 Mobile : l._ (b_)(6_l___ _. 5 Executive Assistant: Ms .._l (b_)( _l _ 6 l._ (b_)( _l _ ___.l - Appointments and Scheduling _. @va.gov Office : 202-382-3792 From: .... l(b_)(_6 )______ _. Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot , John ; Cashour, Curtis; Hutton , James ; Nicholas , Kirk ; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S . (CFM) ; Shelby , Peter J.; Morris, Genevieve (OS/ONC/IO); Windom, John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Ander son, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leader s, please task these out ASAP . We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, soo ner if possible. A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good .com) VA-18-0298-I-000051 Page 887 of 10~ of 1380 Document ID: 0.7.1705.556237 ...._)(_6 )______ l(b ___,~ /o=va/ou=exchange From: administrative group (fydibohf23spdlt)/cn=recipients/cn=vacohaverc> Morris, Genevieve (OS/ONC/IO) To: l(b)(6) lcyhhs.gov> Sandoval, Camilo J. Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 20 18 09:04:02 EDT image001.png Definitely agree that we aren 't giving them a list. Need an answer as it would have been in the hearing ...Genevieve, can you take a stab at that? Thanks! (b_)(G_ )_ Kindly J.... ____. ~I/Special Assistant/ 6 l(b_)(_ l_____ .... 5 Emai1l.... (b_)(_l_____ OCLA / Department of Veterans Affairs __.l @va.gov / Phone : 202-46 1-6434 / Mobile: l(b ...._)(_6 l___ ___, 810 Vermont Ave/ Washington , D.C , NW 20420 From: Windom, John H. Sent: Thur sda , June 28, 2018 8:26 AM To (b) (6) va.gov> !(b_)(_G)___ va.gov>; 'Morris, Genevieve (OS/ONC/IO)' .... ~ VA-18-0298-I-000052 Page 890 of 10~ of 1380 l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr John A.Electronic Health Record Modernization EHR modern ization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records- requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system. During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. *Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va .gov Office: (202) 461-5820 Mobile:.... l(b_)(_s )____ _. Executive Assistant: Ms ..-l (b-)(-S)-~' (b-)(-S)--~ ~va.gov ...... I- Appointments and Scheduling Office : 202-382-3792 VA-18-0298-I-000053 Page 891 of 10~ of 1380 6l_____ From: ~l (b_)(_ ~ Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot, John; Cashour, Curtis; Hutton , James ; Nicholas, Kirk; Jensen , Jon M.; Clancy , Carolyn; Fiotes, Stella S. (CFM); Shelby, Peter J.; Morris, Genevieve (OS/ONC/IO); Windom, John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leader s, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, soone r if possible . A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good .com) VA-18-0298-I-000054 Page 892 of 10~ of 1380 Document ID: 0.7.1705.556235 From: Morris, Genevieve (OS/ONC/1O) l(b)(6) @hhs.gov> To: Windom, John H. (b)(6) ; Sandoval, Camilo J. Cc: Bee: [EXTERNAL] RE: OEHRM Subject: Thu Jun 28 2018 09:00:26 EDT Date: Attachments: image001.png I think we should hold unless asked for the list. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) l(b)(6) I(m) www.healthit.gov I Health IT Buzz Blog I @ONC_HealthlT From: Windom, John H.< John.Windom@va .gov> Sent: Thursday, June 28, 2018 8:34A~_M_____ ~ To : Morris, Genevieve (OS/ONC/IO) l(b)(6) @hhs.gov> J(b)(6) l(b)(6) @va .gov>; Sandoval, Camilo J. ----------~ Subject: RE: OEHRM Do you want to hold or offer the entire list? JW VA-18-0298-I-000055 Page 895 of 10~ of 1380 John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office: (202) 461-5820 Mobile : l(b)(G) ._ ____ M _.sJ'""'" (b.,...,.. )(G ,..,... ) ---.1 Executive Assistant: ~' (b-)(-G)--~ ~va.gov ~----~ - Appointments and Scheduling Office : 202-382-3792 From: Morris, Genevieve (OS/ONC/IO) ..... l(b_)(6_l ______ Sent: Thur sday, June 28 2018 8·32 AM To: Windom, John H.;l..... (b_)(6_l_____ ~ Cc: Sandoval, Camilo J. Subject: [EXTERNAL] Re: OEHRM _.~ @hhs.gov ] I'm good with the below. On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts . I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr VA-18-0298-I-000056 Page 896 of 10~ of 1380 John A) Electronic Health Record Modernization EHR modernization-a historic , multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system. During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner. * Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 externa l executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office: (202) 461-5820 Mobile :l.... (b_)(5_l ____ ~ Executive Assistant: Ms.~l (b_)(_6l__ l(b_)(6_l _ __,~va.gov .... ~I -Appointments and Schedu ling Office : 202-382-3792 From:~l (b_)(_S_ ) ------~ VA-18-0298-I-000057 Page 897 of 10~ of 1380 Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes, Stella S. (CFM) ; Shelby, Peter J.; Morris, Genevieve (OS/ONC/IO); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders , please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, sooner if possible. A-OP IA/Traci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good .com) VA-18-0298-I-000058 og~ of 1380 Page 898 of 1 Document ID: 0.7.1705.555946 From: Windom, John H. To: Morris , Genevieve (OS/ONC/1O) l(b)(6) @hhs.gov> ; Haversto ck, Cathleen ; Sandoval , Camilo J . Cc: Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 20 18 08:34:00 EDT Do you want to hold or offer the entire list? JW John H . Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office: (202) 461-5820 l(b_J(_JG ____ Mobile : .... _. l_~I- Appointments Executive Assistant: Ms . .... l(b_J(_6 and Scheduling ._l (b_)(6 _J_ _. @va.gov Office : 202-382-3792 From: Morris, Genevieve (OS/ONC/1O ~,_ (b"-" )(6 -")______ Sent: Thursday, June 28 , 2018 8:32 AM To: Windom, John H.; .... l(b_J(_GJ_____ _. __. k~hhs.gov ] VA-18-0298-I-000059 Page 901 of 10~ of 1380 Cc: Sandoval, Camilo J. Subject: [EXTERNAL] Re: OEHRM I'm good with the below. On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers . However, it is attached for easy reference . Vr John A) Electronic Health Record Modernizat ion EHR modernization-a historic, multi-billion dollar overhaul of the system used to track veterans' health records-requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperab le system. During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner . * Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclosure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 VA-18-0298-I-000060 oii of 1380 Page 902 of 1 John .Windom@va .gov Office: (202) 461-5820 6 (b_l(_l___ Mobile: l~ ~ Executive Assistant: Ms.l~ (b-)(S - )-~I ~l (b_ )(6_l -~ -Appointments and Schedu ling ~va .gov Office: 202-382-3792 I Fromfb )(S) Sent: Wednesday , June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Caro lyn; Fiotes, Stella S. (CFM) ; Shelby, Peter J.; Morris, Genevieve (OS/ONC/ IO) ; Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow , sooner if possible . A-OP INTraci B, C-VHA/CFM D-OEHRM E-HR&A F-Traci/OPIA Sent with Good (www.good.com) VA-18-0298-I-000061 oi1of 1380 Page 903 of 1 Document ID: 0.7.1705.555947 Sandoval, Camilo J. Windom, John H. ; (b)(G) Morris , Genevieve (OS/ONC/1O) Cc: l(b)(6) @hhs .gov> Bee: Subject: Date: Attachments: RE: OEHRM Thu Jun 28 2018 08:32:33 EDT Looks good to me Camilo Sandoval 202-461-6910 From: Windom , John H. Sent Thursday , June 28, 2018 8:26 AM To: !_ ___.I Executive Assistant: Ms . .__l (b_)(_ - Appointments and Scheduling ~l (b_ )(6_) -~ ~va .gov Office : 202-382-3792 From:l(b)(6) I Sent: Wednesday, June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas , Kirk; Jensen , Jon M.; Clancy , Carolyn; Fiotes, Stella S. (CFM) ; Shelby, Peter J.; Morris, Genevieve (OS/ONC/IO); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: VA-18-0298-I-000063 oi~of 1380 Page 905 of 1 Leaders , please task these out ASAP . We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow , sooner if possible. A-OP IA/Traci B, C-VHA/CFM 0 -OEHRM E-HR&A F-Traci/OPIA Sent with Good (www .good .com) VA-18-0298-I-000064 Page 906 of 1o~~ of 1380 Document ID: 0.7.1705.555944 From: Morris, Genevieve (OS/ONC/1O) l(b)(6) l@hhs.gov> To: Windom, John H. ; l(b)(6) administrative group (fydibohf23spdlt)/cn=recipients/cn=vacohaverc> Cc: Sandoval, Camilo J. Bee: [EXTERNAL] Re: OEHRM Subject: Thu Jun 28 2018 08:32:29 EDT Date: Attachments: I'm good with the below. On: 28 June 2018 08:28, "Windom, John H." wrote: l(b)(6) Subject to review by Genevieve and Camilo, here are my thoughts. I defer to them as to whether we provide the entire list of external reviewers. However, it is attached for easy reference . Vr John A) Electronic Health Record Modernization EHR modernization - a historic , multi-billion dollar overhaul of the system used to track veterans' health records- requires input from specialized professionals to align the VA and U.S. Department of Defense with an interoperable system . During our meeting, you mentioned that you consulted with experts and appropriate parities prior to moving forward with the VA's contract with Cerner . Who specifically did you seek input from on this contract? Did Dr. Bruce Moskowitz or any other individual outside of VA provide input on EHR modernization? As part of VA's overall due-diligence in assessing various aspects of the Electronic Health Record VA-18-0298-I-000065 oi~of 1380 Page 907 of 1 (EHR) Request for Proposal (RFP) and related requirements documents, the EHRM Team utilized 50 external executives and technical/clinical subject matter experts throughout the health care industry. Dr. Moskowitz was one of those 50 experts and was required to sign the requisite VA Non-Disclos ure Agreement as did each of the other participants. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 461-5820 (b_)(6 _)____ Mobile : l~ ~ Executive Assistant: Ms. ~l (b_)(6 _)_~I l~ (b_)(6_)_~ - Appointments and Schedu ling @va.gov Office : 202-382-3792 6)______ FromJ~ (b_)(_ ~ Sent: Wednesday , June 27, 2018 6:59 PM To: Ullyot , John; Cashour, Curtis; Hutton, James ; Nicholas, Kirk; Jensen , Jon M.; Clancy , Carolyn ; Fiotes , Stella S. (CFM) ; Shelby, Peter J.; Morris, Genevieve (OS/ONC/ IO); Windom , John H.; Scott, Traci A CIV OSD OUSD P-R (US) Cc: O'Connor, Christopher; Anderson, Christopher; Powers, Pamela J SES OSD OUSD P-R (US) Subject: Leaders, please task these out ASAP. We must have them back to the Committee by COB on Friday and first to SecVA Nominee and then WH. Need them NLT COB tomorrow, sooner if possible. A-OPINTraci B, C-VHNCFM D-OEHRM E-HR&A F-Traci/OPIA VA-18-0298-I-000066 oiiof 1380 Page 908 of 1 Sent with Good Page 909 of 1380 Document ID: 0.7.1705.553719 From: Morris , Genevieve (OS/ONC/1O) l(b)(6) @hhs.gov> To: Cashour, Curtis ; Ashkenaz , Peter (OS/ONC) (b)(6) hhs.gov> ; Sandoval , Camilo J. Cc: Ullyot , John ; Spero , Casin D. Bee: [EXTERNAL] RE: this accurate? Subject: Mon Jun 25 2018 17:39:35 EDT Date: image001.png Attachments: RE: soi hear you are new CHIO of EHRM? (2).msg Also , I got the attached from Arthur. So not sure which he's running with. Genevieve Morris Detailed to the Veterans Affairs Office of the Secretary Principal Deputy National Coordinator Office of the National Coordinator for Health IT U.S. Department of Health and Human Services (202) 774-3080 (o) ._l (b)_(s)__ _.I(m) www .healthit.gov I Health IT Buzz Blog I @ONC_HealthlT From: Cashour , Curtis Sent: Monday, June 25, 2018 5:27 PM (b-)(6-)----~ @hhs.gov> ; Ashkenaz, Peter (OS/ONC) l~ (b_)(S _)_~ To: Morris, Genevieve (OS/ONC/IO) !~ l(b)(6) ~hhs.gov>; Sandoval, Camilo J. Cc: Ollyot, John ; Spero, Casin D. Subject: RE: this accurate? VA-18-0298-I-000068 Page 91 0 of 10ii of 1380 Folks - is everyone OK with the following response: We have no personnel announcements at this time. ON BACKGROUND: John Windom is not leaving VA and will remain in his current position. Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va.gov @curtcashour From: Cashour, Curtis M_____ __, Sent: Monday, June 25, 2018 5:17 P,,_ To: Morris Genevieve (OS/ONC/IO) l(b)(6) @hhs.gov>; Ashkenaz, Peter (OS/ONC) l(b)(G) l(b)(6) @hhs.gov>; Sandoval, Camilo J. Cc: Ullyot, John ; Spero, Casin D. Subject: FW: this accurate? Please See below ... Let me know if you have concerns or anything to add. Thanks. From: Arthur Allen [mailto :aallen@politico .com] Sent: Monday, June 25, 2018 5:12 PM To: Cashour, Curtis Subject: [EXTERNAL] this accurate? VA-18-0298-I-000069 Page 911 of 10ii of 1380 The Department of Veterans Affairs today reorganized the office responsible for implementing the modernization of its EHR and named an ONC official to lead it. Genevieve Morris , the principal deputy national coordinator for health IT, will become chief health information officer of the Office of the Electronic Health Record Modernization, which is respons ible for moving the VA from its VistA EHR system to a Gerner system . The EHRM had been led by John Windom, who oversaw the acquisition of the Gerner system by the Pentagon and was appointed by former VA Secretary David Shulkin to lead the Gerner impleme ntation as well after Shulkin announced it in June 2017. Windom, a military captain, has been rumored to be departing the VA position for severa l weeks. Arthur Allen Editor, eHealth , POLITICO Author, The Fantastic Laboratory of Dr. Weigl (WW Norton) 202-365-6116 VA-18-0298-I-000070 Page 9 12 of 10~a of 1380 Document ID: 0.7.1705.516366 From: Sandoval, Camilo J. To: Cashour, Curtis ; Fleck , Robert R. (OGC) Cc: Ullyot , John ; Hutton, James ; Windom, John H. ; Morris, l@hhs.gov> ; l(b)(6) Genevieve (OS/ONC/1O) !{b)(6) l(b)(G) ~/o=va/ou =visn 03/cn =recipients/cn =vhaeastruexm> ; Duerinck, Lea E. (OGC) I Bee: Subject: Date: Attachments: RE: [EXTERNAL] MITRE report on EHR Thu May 31201813 :00:00 EDT VA EHRM Interoperability Review Report Executive Summary Jan 2018 FINAL .PDF VA EHRM Interoperability Review Report Jan 2018 FINAL.PDF attached Camilo Sandoval 202-461-6910 From: Cashour, Curtis Sent: Thursday , May 31, 2018 12:37 PM To: Fleck, Robert R. (OGC) ; Sandoval, Camilo J. Cc: Ullyot, John; Hutton , James ; Windom , John H.; Morris , Genevieve (OS/ONC/1O); l(b)(G) Duerinck , Lea E. (OGC) ._ ____ Subject: RE: [EXTERNAL] MITRE report on EHR __. Can someone share the reports with me and I will work with OGC to see if they are releasable? Thanks, VA-18-0298-I-000071 11of 1380 Page 917 of 10 Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Fleck , Robert R. (OGC) Sent: Thursday, May 31, 201812 :27 PM To: Cashour, Curtis ; Sandoval, Camilo J. Cc: Ullyot, John ; Hutton , James ; Windom , John H. ; Morris , Genevieve (OS/ONC/1O) ;l(b)(6) l(b)(6) @va.gov>; Duerinck, Lea E. (OGC) Subject: RE: [EXTERNAL] MITRE report on EHR I Most likely the last two. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege . Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552 . Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party , please delete this information immediately and notify the sender . Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege. VA-18-0298-I-000072 Page 918 of 10~ of 1380 From: Cashour, Curtis Sent: Thursday, May 31, 201812 :22 PM To: Fleck, Robert R. (OGC) ; Sandoval , Camilo J . Cc: Ullyot, John; Hutton , James ; Windom , John H.; Morris, Genevieve (OS/ONC/10); ._l (b_)(_G)____ Duerinck , Lea E. (OGC) Subject: RE: [EXTERNAL] MITRE report on EHR _. What is the main report that the public is aware of? Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va.gov @curtcashour From: Fleck, Robert R. (OGC) Sent: Thursday, May 31, 201812:12 PM To: Sandova l, Camilo J . Cc: Ullyot, John ; Hutton , James ; Windom , John H. hhs .gov>; Cashour, ; Morris Genevieve OS/ONC/IO b 6 Curtis ;( b)(6 ) va.gov>; Duerinck, Lea E. (OGC) Subject: RE: [EXTERNAL] MITRE report on EHR Mr. Sandova l, There are several MITRE reports prepared for the EHR acquisition. The reports are: Red Team Review (VA EHRM Listening Forum): Best Practice Insights - September 7, 2017 Blue Team Review: Independent Assessment - September 29 , 2017 VA-18-0298-I-000073 Page 919 of 10% of 1380 MITRE Interoperability Review and Report - February 1, 2018 Interoperability Review Report -MITRE/law firm report The MITRE Interoperability Review and Report - February 1, 2018, was requested by a private equities firm on February 28, 2018. The report has not been released and is currently in the queue for FOIA review. Once we understand which report(s) the reporter has requested, the request for the report(s) could be treated as a FOIA request. An answer to a FOIA request would take some time. If we would like to provide the report(s) more responsively, the report(s) could be reviewed in accordance with FOIA principles, i.e., redacted for proprietary material, personally identifiable information and other protected information, and then released. However , a rationale supporting a different process for the prior reque st now in the queue would be needed .. As you may be aware, CliniComp currently has an appeal to the Federal Circuit on a ruling by the Court of Federal Claims denying a protest of the award to Gerner . As a result , In addition to the FOIA analysis, any release will need to be coordinated with DOJ. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington , DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender . If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege. VA-18-0298-I-000074 o~iof 1380 Page 920 of 1 From: Sandoval, Camilo J. Sent: Thursday, May 31, 2018 10:14 AM To: Cashour, Curtis; Fleck , Robert R. (OGC) Cc: Ullyot, John; Hutton , James; Windom , John H.; Morris , Genevieve (OS/ONC/IO) Subject: RE: [EXTERNAL] MITRE report on EHR Bob , Is the Mitre report still considered classified at this point in time? A reporte r from the Wall Street Journal is inquiring below . Thank you, Camilo From: Cashour, Curtis Sent: Thursday, May 31, 2018 6:10 :42 AM To: Sandoval, Camilo J. Cc: Ullyot, John; Hutton , James Subject: RE: [EXTERNAL] MITRE report on EHR Do you have time to discuss the below this morning? Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Benjamin Kes ling [mailto:ben.kesling@wsj.com] Sent: Thursday, May 31, 2018 7:32 AM To: Cashour, Curtis Subject: Re: [EXTERNAL] MITRE report on EHR The decision was made weeks ago, but it will have enduring effects and I am trying to piece together what those will be and what went into the thought process . This seems to be a report that has a VA-18-0298-I-000075 Page 92 1 of 1o~ of 5 1380 repository of relevant data and since a decision has been made, ought to be publicly available by this time. I'd also very much like to speak with the top information officer at VA about the way forward with the Cerner contract and open-architecture issues. Thanks very much Ben Ben Kesling Staff Reporter The Wall Street Journal +1 312-273-2152 Iraq mobile +964 751 236 8527 @bkesling On May 30, 2018 , at 14:47, Cashour, Curtis wrote: Thanks, Ben. That decision was made weeks ago. Can you walk me through the angle your piece a bit? Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Ben Kesling [mailto:ben.kesling@wsj.com] Sent: Tuesday , May 29, 2018 5:34 PM To: Cashour, Curtis Subject: Re: [EXTERNAL] MITRE report on EHR I'm writing about the EHR decision and would like to have the report that helped inform the decision . I'm putting together something initially by the end of the week. If the report is not going to be widely distributed or available it could affect timeline. VA-18-0298-I-000076 Page 922 of 1o~~ of 1380 Thanks, Ben On Tue , May 29, 2018 at 5:05 PM, Cashour, Curtis wrote: I will check. What is the specific angle of your story and deadline? Thanks , Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt.Cashour@va .gov @curtcashour From: Ben Kesling [mailto:ben .kesling@wsj .com] Sent: Tuesday , May 29, 2018 4:44 PM To: Cashour, Curtis Subject: [EXTERNAL] MITRE report on EHR Curt, Could I get a copy of the Mitre report on EHR implementation from earlier this year and which I don't think has been publicly released? Thank you , Ben Ben Kesling VA-18-0298-I-000077 Page 923 of 1o~ of 7 1380 Staff Reporter The Wall Street Journal +1 312-273-2152 Iraq mobile +964 751 236 8527 @bkesling Ben Kesling Staff Reporter The Wall Street Journal +1 312-273-2152 Iraq mobile +964 751 236 8527 @bkesling VA-18-0298-I-000078 Page 924 of 1o~~ of 1380 Document ID: 0.7.1705.473432 Sandoval, Camilo J. (b)(6) Cc: Bee: Subject: RE: Talking Points for EHRM Signing Day Date: Mon May 14 2018 21:15 :10 EDT Attachments: image002.png image003 .jpg Thank you~ .. finally catching up with email. l(b_J(_ GJ______ _. From: ..... Sent: Monday, May 14, 201810 :08 AM To : Sandoval , Camilo J. Subject: FW: Talking Points for EHRM Sign ing Day Cam , FYI. .. I noted that you are not on this trail. Kindly, ~ 5 l~ (b_J(_l_____ 6l_____ l(b_J(_ Email: ..... ~~ Special Assistant/ OCLA / Department of Veterans Affairs 5 ..... @va.gov / Phone: 202-461-6434 / Mobile:~l (b-J(_l___ ~ 810 Vermont Ave/ Washington, D.C , NW 20420 From: Hutton , James Sent: Monday, May 14, 2018 9:56 AM To: Duke , Laura ; Ullyot , John ; l(b)(6) l(b)(6) @va.gov>; Windom, John H.; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; I VA-18-0298-I-000079 Page 982 of 10% of 1380 Murray, Edward ; Jones, LaKeesha D. ; Shea, Kristina ; Cos mas, Laura M. (BAH) ; Gabbert, Jeffrey A.(M ission) ; Yow, Mark W . ; Cha ndler , Richard C . · Zenooz Ashw ini Cc: (b)(6) SubJect: RE: I alking Points for EHRM Signing Day Add ing Dr. Zenooz James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affair s Department of Veterans Affairs 810 Vermont Ave , NW Washington , D.C . 20420 Office : 202-461-7558 Email: jame s.hutton @va.gov Twitter : @jehutton VA on Facebook . Tw itter . YouTube . Flickr. Blog From: Hutton , James Sent: Monday , May 14, 2018 9:54 AM To: Duke , Laura ; Ullyot , John ; Haverstock, Cathleen ; Windom , John H. ; Tuc ker, Broo ks ; Cashou r, Curtis ; O'Rourke, Peter M. ; Powers, Pame la ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D. ; Shea , Kristina ; Cos mas, Laura M. (BAH) ; Gabbert, Jeffrey A.(M ission) ; Yow, Mark W . ; Cha ndler, Rir.~acd C Cc : (b)(6) VA-18-0298-I-000080 oiiof 1380 Page 983 of 1 Subject: RE: Talking Points for EHRM Signing Day Laura, Please develop a questions/answers based on the points raised in the article below. This is certain to be a focus of reporters in upcoming media engagements by the acting Secretary (and others). Will the points raised in the article have an impact on our decision/implementation? https ://www. politico.com/story/2018/05/11 /ku sh ner-backed-hea Ith-ca re-project-gets-devastating-review53584 7?cid=apn Kushner-backed health care project gets 'devastating' review The Pentagon report could delay the VA's plans to install the multibillion-dollar software project begun under Obama. ARTHUR ALLEN 05/11/2018 04:54 PM EDT The first stage of a multibillion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO . The April 30 report expands upon the findings of a March POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients , or even kill them . Experts who saw the Pentagon evaluation - it lists 156 "critical" or "severe " incident reports with the potential to result in patient deaths - characterized it as "devastating. " "Traditionally, if you have more than five [incident reports] at that high a level , the program has significant issues, " a member of the testing team told POLITICO. The project's price tag and political sensitivity - it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade - means it is "just another 'too big to fail' program ," the tester said. "The end result everyone is fami liar with - years and years of delays and many billions spent trying to fix the mess. " The unclassified findings could further delay a related VA contract with Gerner Corp. , the digital health records company that began installing the military's system in February 2017. The VA last year chose Gerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama. In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November. "MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. VA-18-0298-I-000081 Page 984 of 1 O~r of 1380 Raquel Bono, chief of the Defense Health Agency. "Feedback from the test community and dedicated professionals at the sites has been invaluable." A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD's contract with Cerner. He did advise VA officials last year to contract with Cerner because the military was already using the vendor , and he argued the creat ion of a seamless, unified system would allow records to be shared between military and VA treatment centers . "He still believes that the decision to move the VA to Cerner was the right one," the spokesman said, but noted that Kushner has advocated for "moving slowly, methodically and properly " with the VA contract to avoid the problems experienced by the military hospitals. POLITICO reported last month that the VA contract has been delayed by concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter , who has advised the president on veterans ' issues , and West Palm Beach doctor Dr. Bruce Moskowitz , who got White House approval to participate in the discussions. VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date , indications are they plan to sign it. Doctors and IT specialists working at the pilot sites break into two groups , according to another wellplaced source: those who think there is a path to make the system work - although it will take at least a year - and those who think there is no hope for it. Two Cerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract, Leidos Health , were to blame for many of the early problems. Cerner, not Leidos , would be the lead contractor for the VA contract. The Pentagon report conc luded that the new software system, called MHS Genesis, is "neither operationally effective, nor operationally suitable" -- and recommended freezing the rollout indefin itely until it can be fixed . In another alarming finding, it disc losed "two indications that MHS Genesis may not be scalab le," meaning it may be impossible to build it out through the entire military health system, which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world . Testers noticed that each time a new hospital went live, the ear lier sites suffered software slowdowns. In addition, the "drop-down" selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For examp le, users need to search through a list of every provider in the entire system to schedule a patient appointment. "Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis," the report says. Doctors and IT officials involved in the project comp lained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system. Four physicians at Naval Station Bremerton , in the Puget Sound, the first hospital to go online, described a stressful atmosphere in which prescription requests came out wrong at the pharmacy, referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible. The Pentagon evaluation , mostly done last fall, went so badly that the testing team stopped after visiting three of the four sites so the military could fix the problems , the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma, Wash., was to be examined later this year. Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could VA-18-0298-I-000082 Page 985 of 1o~~ of 1380 not work on a military-wide scale. They said the implementation problems were nothing they had not encountered in major commercial IT projects, and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022. As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day, said Col. Michael Place, commander of Madigan Army Medical Center , the largest of the four installations . "As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed ," Place said. "We take perverse pride in reporting all those things ." But former VA and military IT officials , and two investigators who saw the report, were skeptical. "The language they use in this report is blunt," said a source with experience examining military contracts. "And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward." "You'll continue to hear that they just made significant updates to the system , and that no one is saying to pull the plug on the program ," said the tester , who said he would be fired if his identity were released. "If DoD members , including all the healthcare professionals at those sites were actually able to freely speak , you would hear most of them calling for something else ." Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Cerner record system in Washington and Oregon next year , linking it to the military's pilot implementation . That effort could be imperiled if the military fails to improve its system beforehand, a congressional source said. "For now , there 's nothing to build on." James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave, NW Washington, D.C. 20420 Office: 202-461-7558 Email: james.hutton@va .gov Twitter : @jehutton VA on Facebook . Twitter. YouTube. Flickr. Blog VA-18-0298-I-000083 Page 986 of 1o~~ of 1380 From: Duke, Laura Sent: Friday , May 11, 2018 3:27 PM To: Ullyot, John ; l(b)(6) @va .gov>; Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M.; Powers, Pamela ; Hutton, James ; Rychalski , Jon J. ; Murray , Edward ; Jones, LaKeesha D. ; Shea , Kristina ; Cosmas , Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 From: Hayden, Nichole M. EOP/OMB l(b)(G) @omb.eop.gov] Sent: Friday , May 11, 2018 2:16 PM To: Duke , Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia ; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeable use of EHR , EHRM , EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in VA-18-0298-I-000084 oi~of 1380 Page 987 of 1 any of the documents. Thanks, 0MB From: Duke, Laura Sent: Thursday, May 10, 2018 5:53 PM (b-)(-6)-----~ @omb.eop .gov>; Hayden, Nichole M. To : Goldstein, Jeff D. EOP/OMB ~l EOP/OMBl(b)(6) l@omb.eop.gov>; Byrd, Dylan W. EOP/OMB l(b)(6) @omb. eop.gov> Cc: Rychalski , Jon J. ; Schmitt, Tricia Subject: FW: Talking Points for EHRM Signing Day Importance: High Jeff and team , for your review, drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000085 oi~of 1380 Page 988 of 1 VA-18-0298-I-000086 Page 989 of 1o~~ of 1380 Document ID: 0.7.1705.473403 From: Sandoval, Camilo J. To: Tucker, Brooks Cc: Bee: Subject: RE: Talking Points for EHRM Signing Day Date: Mon May 14 2018 21:13 :16 EDT Attachments: Thank you sir. Just catching up with emails. From: Tucker, Brooks Sent: Monday , May 14, 2018 10:27 AM To: Sandoval, Camilo J. Subject: FW: Talking Points for EHRM Signing Day From: Powers , Pamela Sent: Monday , May 14, 201810 :24 AM To: Hutton , James; Duke , Laura ; Ullyot, John; Haverstock, Cathleen ; Windom, John H.; Tucker , Brooks ; Cashour , Curtis; O'Rourke , Peter M.; Rychalski , Jon J.; Murray , Edward ; Jones , LaKeesha D.; Shea , Kristina· Cosmas Laura M. BAH · Gabbert Jeffre A. Mission · Yow Mark W .· Chandler Richard C. Cc: (b)(6) Please see attached . This was the DoD TPs in response. Pam Sent with Good (www.good .com) From: Hutton, James Sent: Monday, May 14, 2018 6:53:57 AM VA-18-0298-I-000087 oi1'of 1380 Page 994 of 1 To: Duke , Laura; Ullyot, John ; l(b)(6) !Windom, John H.; Tucker, Brooks; Cashour , Curtis ; O'Rourke , Peter M.; Powers , Pamela; Rycha lski, Jon J .; Murray , Edward; Jones , LaKeesha D.; Shea, Kristina ; Cosmas , Laura M. (BAH); Gabbert, Jeffrey A. (Mission); Yow, Mark W.; Chandler, Richard C. Cc: l(b)(6) l(b)(6) Subject: RE: Talking Points for EHRM Signing Day Laura , Please develop a questions/answers based on the points raised in the article below. This is certain to be a focus of reporters in upcoming media engagements by the acting Secretary (and others). Will the points raised in the article have an impact on our dec ision/implementation? https ://www. politico. com/story /2018/05/11 /ku shner -backed-hea Ith-care-project-get s-deva stating-re view53584 ??cid=apn Kushner-backed health care project gets 'devastating' review The Pentagon report could delay the VA's plans to install the multibill ion-dollar software project begun under Obama. ARTHUR ALLEN 05/11/2018 04:54 PM EDT The first stage of a multibill ion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO . The April 30 report expands upon the findings of a March POLITICO story in which doctors and IT specialists expressed alarm about the softwa re syste m, describing how clinic ians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients , or even kill them . Experts who saw the Pentagon evaluation - it lists 156 "critical " or "severe " incident reports with the potential to result in patient deaths - characterized it as "devastating ." "Traditionally, if you have more than five (incident reports] at that high a level, the program has significant issues," a member of the testing team told POLITICO. The project 's price tag and political sensitivity - it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade - means it is "just another 'too big to fail' program ," the tester said. "The end result everyone is familiar with - years and years of delays and many billions spent trying to fix the mess." The unclassified findings could further delay a related VA contract with Gerner Corp. , the digital health records company that began installing the military's system in February 2017. The VA last year chose Gerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama. VA-18-0298-I-000088 oiiof 1380 Page 995 of 1 In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November. "MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. Raquel Bono, chief of the Defense Health Agency. "Feedback from the test community and dedicated professionals at the sites has been invalu able." A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD 's contract with Gerner. He did advise VA officials last year to contract with Gerner because the military was already using the vendor , and he argued the creation of a seamless, unified system would allow records to be shared between military and VA treatment centers. "He still believes that the decision to move the VA to Gerner was the right one," the spokesman said, but noted that Kushner has advocated for "moving slowly , methodically and properly " with the VA contract to avoid the problems experienced by the military hospitals. POLITICO reported last month that the VA contract has been delayed by concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter , who has advised the president on veterans ' issues , and West Palm Beach doctor Dr. Bruce Moskowitz , who got White House approval to participate in the discussions. VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date , indications are they plan to sign it. Doctors and IT specia lists working at the pilot sites break into two groups, according to another wellplaced source: those who think there is a path to make the system work - although it will take at least a year - and those who think there is no hope for it. Two Gerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract, Leidos Health, were to blame for many of the early problems. Gerner, not Leidos , would be the lead contractor for the VA contract. The Pentagon report concluded that the new software system, called MHS Genesis, is "neither operationally effective , nor operationally suitable" -- and recommended freezing the rollout indefin itely until it can be fixed . In another alarming finding, it disclosed "two indications that MHS Genesis may not be scalab le," meaning it may be impossible to build it out through the entire military health system, which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world . Testers noticed that each time a new hospital went live, the ear lier sites suffered software slowdowns. In addition, the "drop-down" selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For examp le, users need to search through a list of every provider in the entire system to schedule a patient appointment. "Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis," the report says. Doctors and IT officials involved in the project comp lained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system. Four physicians at Naval Station Bremerton , in the Puget Sound, the first hospital to go online, described a stressful atmosphere in which prescription requests came out wrong at the pharmacy , referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible. The Pentagon evaluation , mostly done last fall, went so badly that the testing team stopped after VA-18-0298-I-000089 Page 996 of 1o~~ of 1380 visiting three of the four sites so the military could fix the problems, the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma , Wash ., was to be examined later this year. Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could not work on a military-wide scale. They said the implementation problems were nothing they had not encountered in major commercial IT projects, and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022. As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day, said Col. Michael Place, commander of Madigan Army Medical Center , the largest of the four installations. "As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed," Place said. "We take perverse pride in reporting all those things ." But former VA and military IT officials , and two investigators who saw the report, were skeptical. "The language they use in this report is blunt," said a source with experience examining military contracts. "And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward. " "You'll continue to hear that they just made significant updates to the system , and that no one is saying to pull the plug on the program ," said the tester, who said he would be fired if his identity were released. "If DoD members, including all the healthcare professionals at those sites were actually able to freely speak, you would hear most of them calling for something else. " Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Cerner record system in Washington and Oregon next year, linking it to the military 's pilot implementation . That effort could be imperiled if the military fails to improve its system beforehand, a congressional source said. "For now, there 's nothing to build on." James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave, NW Washington , D.C. 20420 Office: 202-461-7558 Email: james.hutton@va.gov Twitter: @jehutton VA-18-0298-I-000090 Page 99 7 of 108a of 1380 VA on Facebook . Twitter. YouTube . Flickr. Blog From: Duke, Laura Sent: Friday, May 11, 2018 3:27 PM To: Ullyot, John j(b)(6) @va.gov>; Windom, John H.< John.Windom@va .gov> ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M.; Powers, Pamela ; Hutton, James ; Rychalski , Jon J. ; Murray , Edward ; Jones, LaKeesha D.; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow , Mark W.< Mark.Yow@va .gov>; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 6 From: Hayden, Nichole M. EOP/OMB .... l(b-)(_)_______ __, ~omb .eop.gov] Sent: Friday, May 11, 2018 2:16 PM To : Duke , Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia ; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock" schedule prior to release of the documents. VA-18-0298-I-000091 oi1of 1380 Page 998 of 1 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM, EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in any of the documents. Thanks, 0MB From: Duke, Laura Sent: Thursday, May 10, 2018 5:53 PM ,---------, _ To: Goldstein, Jeff D. EOP/OMB (b)(6) omb.eop .gov>; Hayden, Nichole M. EOP/OMB l(b)(6) omb.eop.gov>; Byrd, Dylan W. EOP/OMB j(b)(6) @omb. eop.gov> Cc: Rychalski, Jon J. ; Schmitt , Tricia Subject: FW: Talking Points for EHRM Signing Day Importance : High I Jeff and team , for your review , drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for NSecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000092 oi~of 1380 Page 999 of 1 VA-18-0298-I-000093 Page 1000 of 108~ of 1380 Document ID: 0.7.1705.472786 Windom, John H. Cashour, Curtis ; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Hutton , James ; Duke , Laura ; Ullyot, .-----. John ;._l (b_)(_6)__ ____. (b)(6) /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacohaverc>; Tucker, Brooks ; O'Rourke , Peter M. ; Powers, Pamela ; Rychal ski , Jon J. ; Murray , Edward ; Jones , LaKees ha D. ; Gabbert , Jeffrey A. (Mission) ; Yow, Mark W. ; Chandler, Richard C. ; Sandoval , Camilo J. ; Zenooz , Ashwini Cc: (b)(6) Bee: Subject: Date: Attachments: RE: Talking Points for EHRM Signing Day Mon May 14 2018 18:10 :29 EDT image001.jpg Concur Sir. Thank you for the reaffirmation. VA-18-0298-I-000094 Page 1001 of 10i~ of 1380 Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) 811 Vermont Avenue NW (5th Floor Suite 5080) Washington , DC 20420 John .Windom@va .gov Office: (202) 461-5820 l(b_)(6 _l ___ Mobile : ..... ___, Executive Assistant: Ms.~l (b-)(-G)--~ ~ Appointments and Scheduling 6 _l_ ___, ~va .gov Office : 202-382-3792 ..... 1 (b_)( From: Cashour, Curtis Sent: Monday, May 14, 2018 5:09 PM To: Shea , Kristina; Cosmas , Laura M. (BAH) ; Hutton , James; Duke, Laura ; Ullyot , John ;l(b)(G) Windom, John H.; Tucker , Brooks ; O'Rourke, Peter M.; Powers , Pamela; Ryc..... ha - 1-sk-i,- J-o_n_J-.;~ l(b)(6) Murray , Edward ; Jones , LaKeesha D.; Gabbert, Jeffrey A. (Mission) ; Yow , Mark W .; Chandler , Richard C.; Sandoval, Camilo J.; Zenooz , Ashwini Cc: (b)(6) I (b)(6) ubJect: RE: Talking Points or EHRM igning Day No. DoD shou ld be the only agency responding to quest ions about the Genesis report/Politico artic le. If the Hill staff are asking questions on the Genesis report/Po litico article, they should be referred to DoD. Here is VA's only statement on electronic health records modernization: Finalizing a decision on the Department's electronic health record modernization (EHRM) effort is one VA-18-0298-I-000095 oi~of 1380 Page 1002 of 1 of Acting Secretary Wilkie's top three short-term priorities for VA, given the importance, magnitude and financial investment that this decision represents for Veterans and the department. While VA doesn't typically comment on ongoing contract negotiations, proper due diligence is required to ensure the best interests of Veterans and taxpayers are served before the department enters into any agreement of this size and importance. We are doing that now, and expect to make a final decision and corresponding announcement on EHRM by Memorial Day. Curt Cashour Press Secretary Department of Veterans Affairs 202-461-7388 Curt .Cashour@va .gov @curtcashour From: Shea, Kristina Sent: Monday, May 14, 2018 5:00 PM To : Cosmas, Laura M. (BAH) ; Hutton, James ; Ullyot, John ~(b~)(~6)______ ~ l(b)(6) @va.gov>; Windom , John H.; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J.; Murray , Edward ; Jones, LaKeesha D.< Lakeesha.Jones@va .gov>; Gabbert, Jeffrey A.(Mission); Yow, Mark W.; Chandler, Richard C.; Sandoval, Camilo J. ; Zenooz, ~~fi;'Wr )i Subject: RE: Talking Points for EHRM Signing Day James and team: are these Q&As cleared to share with the hill in response to questions about the Politico article. Our appropriations committees are requesting any information available to refute the claims made in the article. Thanks, Kristy VA-18-0298-I-000096 oiiof 1380 Page 1003 of 1 From: Cosmas, Laura M. (BAH) Sent: Monday, May 14, 2018 12:05 PM To: Hutton, James; Duke, Laura ; Ullyot, John; l(b )(S) Windom, John H.; Tucker , Brooks ; Cashour , Curtis; O'Rourke , Peter M.; Powers, Pamela ; Rychalski, Jon J.; Murray, Edward; Jones, LaKeesha D.; Shea , Kristina ; Gabbert, Jeffrey A. (Mission); Yow, Mark W.; Chandler , Richard C.; Sandoval , Camilo J.; Zenooz, Ashwini Cc: l(b)(6) I l(b)(6) Subject: RE: Talking Points for EHRM Signing Day Mr. Hutton - The below are recommended VA O&As regarding the Politico article . For specific DoD or White House questions , we defer to the DoD and/or WH press office. Please let us know if you have any additional questions, Laura 01 . The report says there are two indications that MHS GENESIS "may not be scalable ", is this a concern for VA? A 1. Ensuring seamless care for Servicemember s and Veterans is a central goal for the EHR effort . In early 2017 , Gerner rigorously tested the scalability of Gerner Millennium to ensure a single VA , DoD and US Coast Guard domain could be maintained , using real-world similar conditions representing up to 100,000 concurrent users. There was no issue with the volume of transactions the system could process during this test, and there was around 40% remain ing processor overhead available . 02 . How has VA incorporated DoD's lessons learned in VA 's deployment plans? A2. VA and DoD are working closely together to ensure lessons learned at DoD sites will enhance future deployments at DoD as well as VA. DoD's biggest challenges have centered on Change Management and User Adoption processes . VA appreciates the candid feedback received from DoD and have incorporated many lessons learned into our planned deployment approach with a greater emphasis on training and user adoption. 03 . Does VA have any concerns that this report will affect your ongoing negotiations with Gerner? A3. During contract negotiations, Gerner has been transparent and working closely with VA about the challenges outlined in this report . By learning from DoD, VA will be able to proactively address these challenges to further reduce potential risks at VA 's first deployment sites . VA-18-0298-I-000097 oi1'of 1380 Page 1004 of 1 Laura Cosmas PMO Support EHRM PEO 202-494-2702 (Mobile) From: Hutton, James Sent: Monday, May 14, 2018 9:54 AM To: Duke , Laura ; Ullyot, John ; Haverstock, Cathleen ; Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M. ; Powers, Pamela ; Rychalski , Jon J.; Murray , Edward ; Jones , LaKeesha D.< Lakeesha.Jones@va .gov>; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mi ssion) ; Yow, Mark W.; Chandler, Richard C. Cc: (b)(6) Subject: RE: Talking Points for EHRM Signing Day Laura, Please develop a questions/answers based on the points raised in the article below. This is certain to be a focus of reporters in upcoming media engagements by the acting Secretary (and others). Will the points raised in the article have an impact on our decision/implementation? https ://www. politico.com/story/2018/05/11 /ku shner-backed-hea Ith-care-project-gets-devastating-review 53584 ??cid=apn Kushner-backed health care project gets 'devastat ing' review The Pentagon report could delay the VA's plans to install the multibillion-dollar software project begun under Obama. ARTHUR ALLEN 05/11/2018 04:54 PM EDT The first stage of a multibillion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO . VA-18-0298-I-000098 oiiof 1380 Page 1005 of 1 The April 30 report expands upon the find ings of a March POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients , or even kill them. Experts who saw the Pentagon evaluation - it lists 156 "critical" or "severe" incident reports with the potential to result in patient deaths - characterized it as "devastat ing." "Trad itionally , if you have more than five [incident reports] at that high a level , the program has significant issues," a member of the testing team told POLITICO. The project's price tag and political sensitivity - it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade - means it is "just another 'too big to fail' program," the tester said. "The end result everyone is familiar with - years and years of delays and many billions spent trying to fix the mess." The unclassified findings could further delay a related VA contract with Gerner Corp., the digital health records company that began installing the military's system in February 2017. The VA last year chose Gerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama. In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November. "MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. Raquel Bono, chief of the Defense Health Agency. "Feedback from the test community and dedicated professionals at the sites has been invaluable." A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD 's contract with Gerner. He did advise VA officials last year to contract with Gerner because the military was already using the vendor, and he argued the creation of a seamless, unified system would allow records to be shared between military and VA treatment centers. "He still believes that the decision to move the VA to Gerner was the right one," the spokesman said, but noted that Kushner has advocated for "moving slowly , methodically and properly " with the VA contract to avoid the problems experienced by the military hospitals. POLITICO reported last month that the VA contract has been delayed by concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter , who has advised the president on veterans ' issues , and West Palm Beach doctor Dr. Bruce Moskowitz , who got White House approval to participate in the discussions. VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date , indications are they plan to sign it. Doctors and IT specialists working at the pilot sites break into two groups, according to another wellplaced source : those who think there is a path to make the system work - although it will take at least a year - and those who think there is no hope for it. Two Gerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract , Leidos Health, were to blame for many of the early problems. Gerner, not Leidos , would be the lead contractor for the VA contract. The Pentagon report concluded that the new software system, called MHS Genesis, is "neither VA-18-0298-I-000099 Page 1006 of 108~ of 1380 operationally effective, nor operationally suitable" -- and recommended freezing the rollout indefin itely until it can be fixed . In another alarming finding, it disclosed "two indications that MHS Genesis may not be scalable ," meaning it may be impossible to build it out through the entire military health system , which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world . Testers noticed that each time a new hospital went live, the earlier sites suffered software slowdowns. In addition , the "drop-down" selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For example , users need to search through a list of every provider in the entire system to schedule a patient appointment. "Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis," the report says. Doctors and IT officials involved in the project complained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system. Four physicians at Naval Station Bremerton , in the Puget Sound, the first hospital to go online, described a stressful atmosphere in which prescription requests came out wrong at the pharmacy , referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible. The Pentagon evaluation , mostly done last fall, went so badly that the testing team stopped after visiting three of the four sites so the military could fix the problems , the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma , Wash. , was to be examined later this year . Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could not work on a military-wide scale . They said the implementation problems were nothing they had not encountered in major commercial IT projects , and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022. As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day , said Col. Michael Place, commander of Madigan Army Medical Center , the largest of the four installations . "As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed," Place said. "We take perverse pride in reporting all those things ." But former VA and military IT officials , and two investigators who saw the report, were skeptical. "The language they use in this report is blunt ," said a source with experience examining military contracts. "And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward." "You'll continue to hear that they just made significant updates to the system , and that no one is saying to pull the plug on the program ," said the tester , who said he would be fired if his identity were released. "If DoD members, including all the healthcare professionals at those sites were actually able to freely speak, you would hear most of them calling for something else. " Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Gerner record system in Washington and Oregon next year, linking it to the military 's pilot implementation. That effort could be imperiled if the military fails to improve its system beforehand, a congressional VA-18-0298-I-000100 q3aof 1380 Page 1007 of 1 source said. "For now, there's nothing to build on." James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave, NW Washington, D.C. 20420 Office: 202-461-7558 Email: james.hutton@va .gov Twitter: @jehutton VA on Facebook . Twitter. YouTube. Flickr. Blog From: Duke, Laura Sent: Friday, May 11, 2018 3:27 PM @va .gov>; To: Ullyot, John :l(b)(G) Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M. ; Powers, Pame la ; Hutton, James ; Rychalski , Jon J. ; Murray , Edward ; Jones, LaKeesha D. ; Shea , Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke VA-18-0298-I-000101 ~% 1of 1380 Page 1008 of 1 202-461-7790 From: Hayden, Nichole M. EOP/OMB l(b)(G) @omb .eop.gov] Sent: Friday , May 11, 2018 2:16 PM To: Duke , Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia ; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM , EHR solution throughout the documents . 3. The coordination effort with HHS and the support to national interoper ability are not mentioned in any of the documents . Thanks, 0MB From: Duke, Laura ·5_3~P~M ~----~ Sent: Thursday, May 10, 2018 5,_ To : Goldstein, Jeff D. EOP/OMB l(b)(G) @omb .eop .gov>; Hayden , Nichole M. EOP/OMB l(b)(G) @omb.eop.gov>; Byrd, Dylan W. EOP/OMB l(b)(G) @omb. eop.gov> Cc: Rychalski , Jon J. ; Schmitt , Tricia Subject: FW: Talking Points for EHRM Signing Day Importance : High Jeff and team, for your review , drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow VA-18-0298-I-000102 Page 1009 of 1~%~ of 1380 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000103 Page 1010 of 1q3~ of 1380 Document ID: 0.7.1705.472680 Cashour, Curtis Shea, Kristina ; Cosmas, Laura M. (BAH) ; Hutton , James ; Duke , Laura ; Ullyot, _,, John ;~l (b_)(_6 )___ ~ (b)( 6 ) /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacohaverc>; Windom, John H. ; Tucker , Brooks ; O'Rourke , Peter M. ; Powers, Pamela ; Rychal ski , Jon J. ; Murray , Edward ; Jones , LaKees ha D. ; Gabbert , Jeffrey A. (Mission) ; Yow, Mark W. ; Chandler, Richard C. ; Sandoval , Camilo J. ; Zenooz , Ashwini (b)(6) Cc: Bee: Subject: Date: Attachments: RE: Talking Points for EHRM Signing Day Mon May 14 2018 17:08:55 EDT image001.jpg No. DoD should be the only agency responding to questions about the Genesis report/Politico artic le. If the Hill staff are asking questions on the Genesis report/Politico article, they should be referred to DoD. VA-18-0298-I-000104 Page 1013 of 1~%~ of 1380 Here is VA's only statement on electronic health records modernization: Finalizing a decision on the Department's electronic health record modernization (EHRM) effort is one of Acting Secretary Wilkie's top three short-term priorities for VA, given the importance, magnitude and financial investment that this decision represents for Veterans and the department. While VA doesn't typically comment on ongoing contract negotiations, proper due diligence is required to ensure the best interests of Veterans and taxpayers are served before the department enters into any agreement of this size and importance. We are doing that now, and expect to make a final decision and corresponding announcement on EHRM by Memorial Day. Curt Cashour Press Secretary Department of Veterans Affairs 202-461 -7388 Curt.Cashour@va .gov @curtcashour From: Shea , Kristina Sent: Monday, May 14, 2018 5:00 PM To: Cosmas, Laura M. (BAH) ; Hutton, James ; 0 11ke I a 11ca ; Ullyot, John (b)(6) l(b)(G) @va.gov>; Windom , John H. _; T =u - c....,. k-e-r,-=s=-r-o_o,..... ks- ; Cashour , Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D. ; Gabbert , Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C.; Sandoval, Camilo J.; Zenooz , Ashwini ; Ullyot, John ; I~(b_)(_G)______ l(b)(6) la)va.gov>; Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D.< Lakeesha.Jones@va .gov>; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow , Mark W.; Chandler, Ricbard Cc:~b)(6) c Subject: RE: Talking Points for EHRM Signing Day Laura, Please develop a questions/answers based on the points raised in the article below . This is certain to be a focus of reporters in upcoming media engagements by the acting Secretary (and others). Will the points raised in the article have an impact on our decision/implementation? https ://www.politico.com/story/2018/05/11 /ku shner-backed-hea Ith-ca re-project -gets-devastating-review53584 7?cid=apn Kushner-backed health care project gets 'devastating' review The Pentagon report could delay the VA's plans to install the multibillion-dollar software project begun VA-18-0298-I-000107 Page 1016 of 1~%~ of 1380 under Obama. ARTHUR ALLEN 05/11/2018 04:54 PM EDT The first stage of a multibillion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO . The April 30 report expands upon the findings of a March POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients, or even kill them . Experts who saw the Pentagon evaluation - it lists 156 "critical" or "severe" incident reports with the potential to result in patient deaths - characterized it as "devastating." ''Traditionally, if you have more than five (incident reports] at that high a level, the program has significant issues," a member of the testing team told POLITICO. The project's price tag and political sensitivity - it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade - means it is "just another 'too big to fail' program ," the tester said. "The end result everyone is fami liar with - years and years of delays and many billions spent trying to fix the mess." The unclassified findings could further delay a related VA contract with Cerner Corp. , the digital health records company that began installing the military's system in February 2017. The VA last year chose Cerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama. In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November. "MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. Raquel Bono, chief of the Defense Health Agency . "Feedback from the test community and dedicated professionals at the sites has been invaluable." A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD 's contract with Cerner . He did advise VA officials last year to contract with Cerner because the military was already using the vendor, and he argued the creation of a seamless, unified system would allow records to be shared between military and VA treatment centers . "He still believes that the decision to move the VA to Cerner was the right one," the spokesman said , but noted that Kushner has advocated for "moving slowly , methodically and properly " with the VA contract to avoid the problems experienced by the military hospitals. POLITICO reported last month that the VA contract has been delayed by concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter , who has advised the president on veterans ' issues , and West Palm Beach doctor Dr. Bruce Moskowitz , who got White House approval to participate in the discussions. VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date , indications are they plan to sign it. Doctors and IT specialists working at the pilot sites break into two groups, according to another well- VA-18-0298-I-000108 Page 1017 of 1q3~ of 1380 placed source : those who think there is a path to make the system work a year - and those who think there is no hope for it. although it will take at least Two Cerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract , Leidos Health, were to blame for many of the early problems. Cerner, not Leidos , would be the lead contractor for the VA contract. The Pentagon report concluded that the new software system, called MHS Genesis, is "neither operationally effective , nor operationally suitable" -- and recommended freezing the rollout indefin itely until it can be fixed . In another alarming finding, it disclosed "two indications that MHS Genesis may not be scalable ," meaning it may be impossible to build it out through the entire military health system , which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world. Testers noticed that each time a new hospital went live, the earlier sites suffered software slowdowns. In addition , the "drop-down " selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For example , users need to search through a list of every provider in the entire system to schedule a patient appointment. "Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis, " the report says. Doctors and IT officials involved in the project complained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system . Four physicians at Naval Station Bremerton , in the Puget Sound, the first hospital to go online, described a stressful atmosphere in which prescription requests came out wrong at the pharmacy , referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible. The Pentagon evaluation , mostly done last fall, went so badly that the testing team stopped after visiting three of the four sites so the military could fix the problems, the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma , Wash ., was to be examined later this year . Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could not work on a military-wide scale . They said the implementation problems were nothing they had not encountered in major commercial IT projects , and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022. As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day , said Col. Michael Place , commander of Madigan Army Medical Center , the largest of the four installations . "As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed ," Place said. "We take perverse pride in reporting all those things ." But former VA and military IT officials , and two investigators who saw the report, were skeptical. "The language they use in this report is blunt ," said a source with experience examining military contracts. "And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward." "You'll continue to hear that they just made significant updates to the system , and that no one is saying to pull the plug on the program ," said the tester , who said he would be fired if his identity were released. "If DoD members, including all the healthcare professionals at those sites were actually able to freely VA-18-0298-I-000109 Page 10 18 of 1q3~ of 1380 speak, you would hear most of them calling for something else ." Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Gerner record system in Washington and Oregon next year, linking it to the military's pilot implementation . That effort could be imperiled if the military fails to improve its system beforehand, a congressional source said. "For now, there 's nothing to build on." James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave , NW Washington , D.C. 20420 Office: 202-461-7558 Email: james.hutton@va .gov Twitter : @jehutton VA on Facebook . Twitter . YouTube. Flickr. Blog From: Duke, Laura Sent: Friday , May 11, 2018 3:27 PM ~@va .gov>; To : Ullyot, John :l(b)(G) Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Hutton, James ; Rychalski , Jon J. ; Murray , Edward ; Jones, LaKeesha D.; Shea , Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to VA-18-0298-I-000110 1i of 1380 Page 1019 of 1~ discuss. The bulk of their substantive comments appear to focus on play ing up the coordination with DOD. Laura Duke 202-461-7790 From: Hayden, Nichole M. EOP/OMB l(b)(6) @omb.eop .gov] Sent: Friday, May 11, 2018 2: 16 PM To: Duke, Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia ; Byrd , Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura , Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeab le use of EHR, EHRM, EHR solution throughout the documents. 3. The coordination effort with HHS and the support to nationa l interoperability are not mentioned in any of the documents . Thanks, 0MB From: Duke , Laura Sent: Thursday, May 10, 2018 5:53 PM To: Goldstein, Jeff D. EOP/OMB -l(b-)(-6)-----~l @omb.eop.gov>; Hat den, Nichole M. EOP/OMB l(b)(6) l@omb.eop.gov>; Byrd, Dylan W. EOP/OMB ~b)(6) t§2omb. eop.gov> Cc: Rychalski , Jon J. ; Schmitt , Tricia Subject: FW: Talking Points for EHRM Signing Day Importance : High VA-18-0298-I-000111 11of 1380 Page 1020 of 1~ Jeff and team, for your review, drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activ ities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000112 Page 102 1 of 1q~~ of 1380 Document ID: 0.7.1705.472670 Shea, Kristina Cosmas, Laura M. (BAH) To: ; Hutton , James ; Duke , Laura ; Ullyot, John ; ,-l (b)(6) /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacohaverc>; Windom, John H. ; Tucker , Brooks ; Cashour, Curtis ; O'Rourke, Peter M. ; Powers , Pamela ; Rychalski, Jon J. ; Murray, Edward ; Jones , LaKeesha D. ; Gabbert, Jeffrey A. (Mission) ; Yow, Mark W . ; Chandler, Richard C. ; Sandoval, Camilo J. ; Zenooz, Ashwini (b)(6) Cc: Bee: Subject: Date: Attachments: RE: Talking Points for EHRM Signing Day Mon May 14 2018 16:59:32 EDT image001.jpg James and team: are these Q&As cleared to share with the hill in response to questions about the Politico article. Our appropriations committees are requesting any information available to refute the VA-18-0298-I-000113 Page 1024 of 1~ ~ of 1 1380 claims made in the article. Thanks, Kristy From: Cosmas, Laura M. (BAH) Sent: Monday , May 14, 2018 12:05 PM lwindom, John H.; Tucker , Brooks; To: Hutton , James; Duke , Laura; Ullyot, John; l(b)( S) Cashour, Curtis; O'Rourke, Peter M.; Powers, Pamela; Rychalski, Jon J.; Murray, Edward; Jones, LaKeesha D.; Shea, Kristina ; Gabbert, Jeffrey A. (Mission); Yow, Mark W.; Chandler, Richard C.; Sandova l, Camilo J.; Zenooz, Ashwini Cc f I< •: l(b)(6) S>i ect: RE: 1 alkmg Points for EHRMS1gnmgDay Mr. Hutton - The below are recommended VA Q&As regarding the Politico article. For specific DoD or White House questions, we defer to the DoD and/or WH press office. Please let us know if you have any additional questions, Laura Q1. The report says there are two indications that MHS GENES IS "may not be scalable", is this a concern for VA? A 1. Ensuring seamless care for Servicemembers and Veterans is a central goal for the EHR effort. In early 2017, Gerner rigorously tested the scalabi lity of Gerner Millennium to ensure a single VA, DoD and US Coast Guard domain could be mainta ined, using real-world similar condit ions representing up to 100,000 concurrent users. There was no issue with the volume of transactions the system could process during this test , and there was around 40% remaining processor overhead available. Q2. How has VA incorporated DoD's lessons learned in VA's deployment plans? A2. VA and DoD are working closely together to ensure lessons learned at DoD sites will enhance future deployments at DoD as well as VA. DoD's biggest cha llenges have centered on Change Management and User Adoption processes . VA appreciates the candid feedback received from DoD and have incorporated many lessons learned into our planned deployment approach with a greater emphasis on training and use r adoption. VA-18-0298-I-000114 Page 1025 of 1~ ~ of 1 1380 03. Does VA have any concerns that th is report will affect your ongoing negotiations with Cerner? A3. During contract negotiations, Cerner has been transparen t and working closely with VA about the challenges outlined in this report. By learning from DoD, VA will be able to proactively address these challenges to furthe r reduce potential risks at VA's first deployment sites. Laura Cosmas PMO Support EHRM PEO l-(b)_(6_) !(Mobi le) ___ From: Hutton, James Sent: Monday, May 14, 2018 9:54 AM Jo · Q1Jke I a1Jra; Ullyot , John : l(b)(G) l(b)(G) @va.gov>; Windom , John H.; Tucker, Brooks ; Cashou r, Curt is ; O'Rourke, Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D.< Lakeesha.Jones@va .gov>; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow , Mark W.; Chandler, Richard I c cd: l(b)(6) lvva .gov>; Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M.; Powers, Pame la ; Hutton, James ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D. ; Shea , Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day VA-18-0298-I-000118 1i of 1380 Page 1029 of 1~ All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 (b_)(6 _)_______ _.@omb .eop.gov] From: Hayden, Nichole M. EOP/OMB ._l Sent: Friday, May 11, 2018 2:16 PM To: Duke, Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM , EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in any of the documents. Thanks, 0MB From: Duke, Laura Sent: Thursday, May 10, 2018 5:53 PM ~------To: Goldstein Jeff D. EOP/OMB (b)(6) @omb.eop.gov>; Ha~den, Nichole M. EOP/OMB (b)(6) @omb. , Dylan W. EOP/OMB l(b)(6) eop.gov> Cc: Rychalski, Jon J.; Schmitt, Tricia Subject: FW: Talking Points for EHRM Signing Day VA-18-0298-I-000119 1i of 1380 Page 1030 of 1~ Importance: High Jeff and team, for your review , drafts of the following documents are attached: 1. Press Release - we' ll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activ ities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-46 1-7790 VA-18-0298-I-000120 Page 103 1 of 1q~a of 1380 Document ID: 0.7.1705.472061 From: Cosmas, Laura M. (BAH) To: Hutton, James ; Duke , Laura ; Ullyot, John ; .-l (b-)(-6)__ __, (b)(6) ; Windom, John H. ; Tucker , Brooks ; Cashour, Curtis ; O'Rourke, Peter M. ; Powers , Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D. ; Shea , Kristina ; Gabbert , Jeffrey A. (Mission) ; Yow , Mark W . ; Chandler, Richard C. ; Sandoval , Camilo J. ; Zenooz , Ashwini Cc: (b)(6) Bee: Subject: Date: Attachments: RE: Talking Points for EHRM Signing Day Mon May 14 2018 12:05:05 EDT image001.jpg Mr. Hutton - The below are recommended VA Q&As regarding the Politico article. For specific DoD or White House questions , we defer to the DoD and/or WH press office. VA-18-0298-I-000121 Page 1034 of 1~~ of 1 1380 Please let us know if you have any additional questions, Laura Q1. The report says there are two indications that MHS GENESIS "may not be scalable", is this a concern for VA? A 1. Ensuring seamless care for Servicemembers and Veterans is a central goal for the EHR effort. In early 2017, Cerner rigorously tested the scalability of Cerner Millennium to ensure a single VA , DoD and US Coast Guard domain could be maintained, using real-world similar condit ions representing up to 100,000 concurrent users. There was no issue with the volume of transactions the system could process during this test , and there was around 40% remaining processor overhead available . Q2. How has VA incorporated DoD's lessons learned in VA 's deployment plans? A2. VA and DoD are working closely together to ensure lessons learned at DoD sites will enhance future deployments at DoD as well as VA. DoD's biggest cha llenges have centered on Change Management and User Adoption processes . VA appreciates the candid feedback received from DoD and have incorporated many lessons learned into our planned deployment approach with a greater emphasis on training and user adoption. Q3. Does VA have any concerns that this report will affect your ongoing negotiations with Cerner? A3. During contract negotiations, Cerner has been transparent and working close ly with VA about the challenges out lined in this report . By learning from DoD, VA will be able to proactively address these challenges to further reduce potential risks at VA 's first deployment sites. Laura Cosmas PMO Support EHRM PEO 6 ._l (b)_( _l __ _.!(Mobile) VA-18-0298-I-000122 Page 1035 of 1~~~ of 1380 From: Hutton, James Sent: Monday, May 14, 2018 9:54 AM To: Duke, Laura ; Ullyot, John l(b)(6) (b)(6) va.gov>; Windom , John H.; Tucker, Brooks ; ashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D. ; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. ; To : Ullyot, John J(b)(G) Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M.; Powers, Pamela ; Hutton, James ; Rychalski , Jon J. ; Murray , Edward ; Jones , LaKeesha D. ; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All , please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any quest ions or would like me to arrange a discus sion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 ~ omb.eop.gov] From: Hayden, Nichole M. EOP/OMB l(b)(G) Sent: Friday, May 11, 2018 2: 16 PM To: Duke , Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, VA-18-0298-I-000126 Page 1039 of 1~~i of 1380 Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits prov ided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock" schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM, EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in any of the documents. Thanks, 0MB From: Duke , Laura Sent: Thur sday, May 10, 2018 5:53 PM (b-)(-6)-----------. @omb.eop .gov >; Ha~den , Nichole M. To : Goldstein , Jeff D. EOP/OMB I.EOP/OMB l(b)(6) ~ omb.eop.gov>; Byrd , Dylan W. EOP/OMB l(b)(6) @omb. eop.gov> Cc: Rychalski , Jon J. ; Schmitt , Tricia Subject: FW: Talking Points for EHRM Signing Day Importance: High Jeff and team , for your review , drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you 've been in contact with OPIA on the se documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have VA-18-0298-I-000127 Page 1040 of 1~~~ of 1380 any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000128 Page 1041 of 1q~~ of 1380 Document ID: 0.7.1705.471626 From: Tucker, Brooks To: Sandoval, Camilo J. Cc: Bee: Subject: FW: Talking Points for EHRM Signing Day Date: Mon May 14 2018 10:27:23 EDT Attachments: DOT&E_MHS_GENESIS_Statement _May2018 .pdf IOT&E_MHS_GENESIS _Senior_ Talking_Points_May2018.pdf From: Powers , Pamela Sent: Monday , May 14, 201810 :24 AM Windom , John H.; Tucker , Brooks ; To : Hutton , James; Duke , Laura ; Ullyot, John ; l(b)(S) Cashour , Curti s; O'Rourke , Peter M.; Rychalski , Jon J.; Murray , Edward ; Jones, LaKeesha D.; Shea , Kristina ; Cosmas, Laura M. BAH ; Gabbert , Jeffre A. Mission ; Yow, Mark W .; Chandler , Richard C. Cc: (b)(6) I (b)(6) Subject: RE: Talking Points for EHRM Sign ing Day Please see attached . This was the DoD TPs in response. Pam Sent with Good (www .good .com) From: Hutton, James :5 ~3_:~ 57~ A~ M~--~ Sent: Monday, May 14, 2018 6,__ To : Duke , Laura; Ullyot, John ;l(b)(6) ~indom , John H.; Tucker , Brooks ; Cashour , Curtis ; O'Rourke , Peter M.; Powers , Pamela; Rychalski , Jon J.; Murray , Edward; Jones , LaKeesha D.; Shea , Kristina ; Cosmas , Laura M. (BAH); Gabbert , Jeffrey A. (Mission); Yow, Mark W.; Chandler, Ric_ ............... _______________________________ ___, Cc:(b)(6) Laura, VA-18-0298-I-000129 Page 1044 of 1~~i of 1380 Please develop a questions/answers based on the points raised in the article below. This is certain to be a focus of reporters in upcoming media engagements by the acting Secretary (and others). Will the points raised in the article have an impact on our decision/implementation? https ://www. politico.com/story/2018/05/11 /ku shner-backed-hea Ith-care-project-gets-devastating-review53584 7?cid=apn Kushner-backed health care project gets 'devastating' review The Pentagon report cou ld delay the VA's plans to install the multibill ion-dollar software project begun under Obama. ARTHUR ALLEN 05/11/2018 04:54 PM EDT The first stage of a multibillion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO . The April 30 report expands upon the find ings of a March POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients, or even kill them. Experts who saw the Pentagon evaluation - it lists 156 "critical" or "severe" incident reports with the potential to result in patient deaths - characterized it as "devastating ." ''Traditionally, if you have more than five [incident reports] at that high a level , the program has significant issues," a member of the testing team told POLITICO . The project' s price tag and political sensitivity - it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade - means it is "just another 'too big to fail' program," the tester said. "The end result everyone is familiar with - years and years of delays and many billions spent trying to fix the mess." The unclassified findings could further delay a related VA contract with Gerner Corp., the digita l health records company that began installing the military's system in February 2017 . The VA last year chose Gerner as its vendor, with the belief that sharing the same system wou ld facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama . In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November. "MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. Raquel Bono, chief of the Defense Health Agency. "Feedback from the test community and dedicated professiona ls at the sites has been invaluable." A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD's contract with Gerner. He did advise VA officials last year to contract with Gerner because the military was already using the vendor , and he argued the creation of a seamless, unified system would allow VA-18-0298-I-000130 q~a of 1380 Page 1045 of 1 records to be shared between military and VA treatment centers. "He still believes that the decision to move the VA to Cerner was the right one," the spokesman said, but noted that Kushner has advocated for "moving slowly , methodically and properly" with the VA contract to avoid the problems experienced by the military hospitals. POLITICO reported last month that the VA contract has been delayed by concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter , who has advised the president on veterans ' issues , and West Palm Beach doctor Dr. Bruce Moskowitz, who got White House approval to participate in the discussions. VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date , indications are they plan to sign it. Doctors and IT specialists working at the pilot sites break into two groups, according to another wellplaced source : those who think there is a path to make the system work - although it will take at least a year - and those who think there is no hope for it. Two Cerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract , Leidos Health, were to blame for many of the early problems. Cerner, not Leidos , would be the lead contractor for the VA contract. The Pentagon report concluded that the new software system , called MHS Genesis, is "neither operationally effective , nor operationally suitable " -- and recommended freezing the rollout indefin itely until it can be fixed . In another alarming finding, it disclosed "two indications that MHS Genesis may not be scalable ," meaning it may be impossible to build it out through the entire military health system , which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world . Testers noticed that each time a new hospital went live, the earlier sites suffered software slowdowns. In addition , the "drop-down " selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For example, users need to search through a list of every provider in the entire system to schedule a patient appointment. "Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis ," the report says. Doctors and IT officials involved in the project complained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system. Four physicians at Naval Station Bremerton , in the Puget Sound , the first hospital to go online , described a stressful atmosphere in which prescription requests came out wrong at the pharmacy, referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible. The Pentagon evaluation , mostly done last fall, went so badly that the testing team stopped after visiting three of the four sites so the military could fix the problems , the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma, Wash. , was to be examined later this year. Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could not work on a military-wide scale. They said the implementation problems were nothing they had not encountered in major commercial IT projects, and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022. As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day, VA-18-0298-I-000131 q~rof 1380 Page 1046 of 1 said Col. Michael Place, commander of Madigan Army Medical Center, the largest of the four installations. "As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed," Place said. "We take perverse pride in reporting all those things ." But former VA and military IT officials, and two investigators who saw the report, were skeptical. "The language they use in this report is blunt," said a source with experience examining military contracts . "And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward." "You'll continue to hear that they just made significant updates to the system , and that no one is saying to pull the plug on the program ," said the tester, who said he would be fired if his identity were released. "If DoD members, including all the healthcare professionals at those sites were actually able to freely speak, you would hear most of them calling for something else ." Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Cerner record system in Washington and Oregon next year, linking it to the military's pilot implementation . That effort could be imperiled if the military fails to improve its system beforehand, a congressional source said. "For now, there 's nothing to build on." James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave , NW Washington , D.C. 20420 Office : 202-461-7558 Email: james.hutton@va .gov Twitter : @jehutton VA on Facebook. Twitter. YouTube. Flickr. Blog From: Duke, Laura VA-18-0298-I-000132 Page 1047 of 1q~~ of 1380 Sent: Friday , May 11, 2018 3:27 PM To: Ullyot, John ; l(b)(G) @va.gov>; Windom, John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke, Peter M.; Powers, Pamela ; Hutton, James ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D.; Shea , Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 (b)(6) l L From: Hayden, Nichole M. EOP/OMB ~--------~ rg2omb.eop.gov] Sent: Friday, May 11, 2018 2: 16 PM To : Duke , Laura Cc: Goldstein , Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Sign ing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review. In addition to our line edits provided in the attachments, we have three overarching comments . 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents . 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM , EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in any of the documents. Thanks , VA-18-0298-I-000133 Page 1048 of 1~~~ of 1380 0MB From: Duke, Laura Sent: Thursday, May 10, 2018 5:53 PM To: Goldst~in ,Jeff D EOP/OMB .l(b -)(-6)----------. @omb.eop.gov>; Hayden, Nichole M. EOP/OMB~b)(G) ~ omb.eop.gov>; Byrd, Dylan W. EOP/OMB !(b)(6) @omb . eop.gov> Cc: Rychalski, Jon J. ; Schmitt, Tricia Subject: FW: Talking Points for EHRM Signing Day Importance : High Jeff and team, for your review, drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you've been in contact with OPIA on these documents, so you won't be surprised that we have a HARD deadline of noon tomorrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000134 Page 1049 of 1~~~ of 1380 Document ID: 0.7.1705.471260 l(b)(6) l To: Sandoval, Camilo J. Cc: Bee: Subject: FW: Talking Points for EHRM Signing Day Date: Mon May 14 2018 10:08 :03 EDT Attachments: image001.jpg image002 .png Cam , FYI ... I noted that you are not on this trail. Kindly, l(b)(S) ~l (b_)(_6)____ ~~ Specia l Assistant/ OCLA / Department of Veterans Affa irs 6l_____ Emai1:,....l (b_)(_ 5 ....., @va.gov / Phone: 202-461 -6434 / Mobile:l..... (b-)(_l ___ ~ 81 O Vermont Ave/ Washington , D.C , NW 20420 From: Hutton , James Sent: Monday, May 14, 2018 9:56 AM To: Duke , Laura ; Ullyot , John ; l(b)(S) l(b)(6) @va.gov>; Windom, John H.; Tucker, Brooks ; Cashou r, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski , Jon J. ; Murray, Edward ; Jones, LaKeesha D.< Lakeesha .Jones@va .gov>; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow, Mark W.; Chandler, Ric · · · ,..,,..,..,,r,...1, > Cc: (b)(6) (b)(6) I Adding Dr. Zenooz VA-18-0298-I-000135 Page 1057 of 1~~~ of 1380 James Hutton Deputy Assistant Secretary Office of Public and Intergovernmental Affairs Department of Veterans Affairs 810 Vermont Ave , NW Washington , D.C. 20420 Office: 202-461-7558 Email: james.hutton@va .gov Twitter : @jehutton VA on Facebook . Twitter. YouTube. Flickr. Blog From: Hutton, James Sent: Monday, May 14, 2018 9:54 AM ~ To : Duke , Laura ; Ullyot, John -j(b_)(_6)______ l(b)(6) @va.gov>; Windom , John H. ; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M. ; Powers, Pamela ; Rychalski, Jon J. ; Murray , Edward ; Jones, LaKeesha D.; Shea, Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, Jeffrey A.(Mission) ; Yow , Mark W.< Mark.Yow@va .gov> ; Chandle r, Richard C. ;l(b)(6) @va .gov>; Windom, John H.; Tucker, Brooks ; Cashour, Curtis ; O'Rourke , Peter M.; Powers, Pamela ; Hutton , James ; Rychalski , Jon J. ; Murray , Edward ; Jones, LaKeesha D.; Shea , Kristina ; Cosmas, Laura M. (BAH) ; Gabbert, VA-18-0298-I-000139 Pa ge 1061 of 1~~i of 1380 Jeffrey A.(Mission); Yow, Mark W.; Chandler, Richard C. Subject: FW: Talking Points for EHRM Signing Day All, please see the attached edits from 0MB on our rollout materials, and note their comments below. Please let me know if you have any questions or would like me to arrange a discussion with 0MB to discuss. The bulk of their substantive comments appear to focus on playing up the coordination with DOD. Laura Duke 202-461-7790 6 From: Hayden, Nichole M. EOP/OM~..... (b_)(_ l_______ __,@omb .eop.gov] Sent: Friday, May 11, 2018 2:16 PM To: Duke, Laura Cc: Goldstein, Jeff D. EOP/OMB ; Rychalski, Jon J.; Schmitt, Tricia; Byrd, Dylan W. EOP/OMB Subject: [EXTERNAL] RE: Talking Points for EHRM Signing Day Laura, Attached are the combined 0MB and DPC edits to the documents for your review . In addition to our line edits provided in the attachments, we have three overarching comments. 1. POTUS event and coordination on need to be added to the "tick-tock " schedule prior to release of the documents. 2. We recommend VA check for consistency on the interchangeable use of EHR, EHRM, EHR solution throughout the documents. 3. The coordination effort with HHS and the support to national interoperability are not mentioned in any of the documents. Thanks, 0MB From: Duke, Laura VA-18-0298-I-000140 ~iiof 1380 Page 1062 of 1 Sent: Thursday, May 10, 2018 5:~5_ 3 _P_M____ ~ To: Goldstein Jeff D. EOP/OMB( b)(6) omb.eop .gov>; Hayden , Nichole M. EOP/OMB (b)(6) omb.eop.gov>; Byrd , Dylan W. EOP/OMB Kb)(6) l@omb. eop.gov> Cc: Rychalski, Jon J. ; Schmitt , Tricia Subject: FW: Talking Points for EHRM Signing Day Importance : High Jeff and team, for your review , drafts of the following documents are attached: 1. Press Release - we'll be inserting a quote from A/SecVA sometime tomorrow 2. Media/Phone statement for A/SecVA - left as bullet points 3. Draft email verbiage for A/SecVA to send the VA staff 4. FAQs 5. EHRM Fact Sheet 6. Tick-tock on rollout activities I understand you 've been in contact with OPIA on these documents , so you won't be surprised that we have a HARD deadline of noon tomo rrow for any 0MB edits. Please feel free to reach out if you have any questions or comments, and thanks so much! Laura Duke 202-461-7790 VA-18-0298-I-000141 ~i1of 1380 Page 1063 of 1 Document ID: 0.7.1705.452743 From: Sandoval, Camilo J. To: Spero , Casin D. ; Hayes-Byrd, Jacquelyn ; O'Rourke , Peter M. Cc: Bee: Subject: RE: Please Review Tonight Date: Fri May 04 2018 02:15:40 EDT Attachments: [EXTERNAL] NDA.pdf (1).msg NDA.pdf [EXTERNAL] RE : VA EHR NOA (2) .msg Perlmutter .EHR NOA v2 mbs.pdf [EXTERNAL] Re: VA EHR NOA (3).msg EHR NOA v2 mbs .pdf EHR NOA v2 RL.pdf EHR NOA v2.pdf And in case anyone ask, here are the signed NDA's of Ike, Bruce , and Marc. From: Sandoval , Camilo J. Sent: Friday , May 04, 2018 2:12 AM To: Spero , Casin D.; Hayes-Byrd, Jacquelyn ; O'Rourke, Peter M. Subject: RE: Please Review Tonight Pete- This request from members of congress is based on inaccurate reporting by Arthur Allen from Politico , which was fueled by David Shulkin and Scott Blackburn . In fact , the real outside interference and conflict of interest came from Peter Levin , who was attempt ing to shape the direction of ongoing contract negotiations between the VA and Gerner. According to John Windom and Ash Zenooz, on several occasions Secretary Shulkin suggested to the EHRM team that Peter Levin be hired as a direct contractor. When those efforts failed , Peter Levin then acqu ired VA contracts through MITRE with Secretary Shulkin's influence. Please note that Peter Levin , Scott Gould, Stephen Ondra and Michele Flournoy (married to Scott Gould) all work for or are associated with AMIDA and MITRE . Ironically, they were all senior VA or DOD employees under the Obama administration with access to insider information. A key question Arthur Allen and interested members of congress should investigate and write about is, VA-18-0298-I-000142 Page 1068 of 1qj~of 1380 why did Shulkin and Blackburn continue to communicate with Peter Levin, and put undue pressure on John Windom to hire Peter Levin's firm-AMIDA-as a contractor. Also, why was Shulkin in such a rush to sign the Cerner contract last year(Oct/Nov) when there was over 51 major findings and recommendations added to the contract over the past several months? And for the record, it was a team of top medical Cl Os and practitioners-put together by Ike Perlmutter and Bruce Moskowitz-who identified the flaws in the contract and made the recommendations, not MITRE. MITRE had advised against a strategic pause, and then took credit for the work done after . Please read attachments. From: Spero , Casin D. Sent: Thursday, May 03, 2018 7:31 PM To: Sandoval , Camilo J.; Hayes-Byrd, Jacquelyn ; O'Rourke, Peter M. Subject: RE: Please Review Tonight Good info Cam, we may want to remind the interested parties of that. From: Sandoval , Camilo J. Sent: Thursday, May 03, 2018 4:13 :22 PM To: Hayes-Byrd , Jacquelyn ; O'Rourke , Peter M.; Spero , Casin D. Subject: RE: Please Review Tonight Thank you Jacquie. If we go back to Shulkin 's EHRM hearing testimony , he mentions under oath that he and Scott Blackburn requested outside, non-governmental help from the top 5 Medical CIO's. These experts are who alerted him to the many interoperability issues previously unknown to Gerner or VA staff. From: Hayes-Byrd , Jacquelyn Sent: Thursday, May 03, 2018 5:42 PM To : O'Rourke , Peter M.; Sandoval , Camilo J.; Spero , Casin D. Subject: Please Review Tonight Please see these two documents tonight as the Dep Sec provided this to Colonel Gainey late this afternoon And Andy will be giving it to the Secretary first in the a.m. don't want you to be blindsided and I would like for you to be prepared to discuss. Jacquie VA-18-0298-I-000143 Page 1069 of 1qj~of 1380 From: Washington, Conrad Sent: Thursday, May 03, 2018 5:32 PM To: Hayes-Byrd, Jacquelyn Subject: REQUESTED SCAN Conrad Washington Special Assistant Office of the Secretary 810 Vermont Ave, NW Washington, DC 20420 202-461-7865 (0) Conrad. washington@va.gov VA Core Values: Integrity, Commitment, Advocacy, Respect , and Excellence-I CARE VA-18-0298-I-000144 Page 1070 of 1qj~of 1380 Document ID: 0.7.1705.452743-000001 Owner : Sandoval, Camilo J . Filename: [EXTERNAL] NDA.pdf (1).msg Last Modified: Fri May 04 01:15:40 CDT 2018 VA-18-0298-I-000145 Page 1071 of 1qj 5of 1380 1 Cc:[EXTER~~~W~&8~WrW~i1~gM1!~fBt&WWr1't~1!WgJ1s\:f.c'BffiF,Wib sWJl(man@gmail.com(mbsherman@gmai l.com] To: Blackburn , Scott R. (DISABLED ACCT)[Scott .Blackburn@va.gov] ;l(b)(6) H.(John.Windom@va.gov ] From: Bruce Moskowitz Sent: Tue 3/13/2018 6:59:21 PM Subject: [EXTERNAL] NDA.pdf NDA.pdf @va.gov]; Windom, John Sent from my iPad Bruc e Moskowitz M.D. VA-18-0298-I-000146 Page 1072 of 19ii of 1380 Document ID: 0.7.1705.452743-000003 Owner : Sandoval, Camilo J . Filename: [EXTERNAL] RE: VA EHR NOA (2).msg Last Modified: Fri May 04 01:15:40 CDT 2018 VA-18-0298-I-000147 qj7of 1380 Page 1076 of 1 From: Sent: Subject: IP Tue 3/13/2018 6:07:06 PM [EXTERNAL] RE: VA EHR NOA Perlmutter.EHR NOA v2 mbs.pdf At tac hed is my signed NOA. Tha nk yo u. From: Marc Sherman l(b)(G) @gmail.com] Sent: Tuesday, March 13, 2018 1:40 PM To: Blackburn, Scott R. Eilipnail.com; Bruce Moskowitz; ,_l (b_)(_6_) ___ Cc: IP; !ib)/6) Subject : Re: VA EHR NDA _.l Windom, John H.; DJS Scott, l(b)(G) land John Thank you for the NDAdraft that you sen t along and the organized approach. to close the loop : 1. a marked up version of the NDA with a few necessary adjustments I have attached the following 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 version 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 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. (b_)(_6 l__ 1) We will need you to sign the attached NDA. Please return to~l _.kcc' d). 2) Matt 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 phon~ that we can orient you to the contract and help focus you on the parts where your expertise will be most valuable.~ ~ (who is the overnment contracting officer) and John Windom (who is our EHR leader) will lead this from our (cc'd) here to help set up a time. We can either do this all together, if calendars match up, or side. I will as (b)(6 ) 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 NDA and we are working with them. I am hoping to connect with Dr. Cooper today. Thanks again! Scott Scott Blackburn Acting CIO & Executive-in-Cha rge, Office of Informati on & Technology Department of Veterans Affairs VA-18-0298-I-000148 Page 1077 of 19ii of 1380 [EXTERNAL) RE: VA EHR NOA (2).msg for Printed Item : 171 ( Attachment 3 of 8) VA-18-0298-I-000149 Page 1078 of 1q~~ of 1380 Document ID: 0.7.1705.452743-000005 Owner : Sandova l, Camilo J . Filename: [EXTERNAL] Re: VA EHR NOA (3).msg Last Modified: Fri May 04 01:15:40 CDT 2018 VA-18-0298-I-000150 qga of 1380 Page 1082 of 1 8 ) ·~f'h7~~~.3(!5f§A~tr~rsei~eff~t:il\~§idc?~~t1'rfr@U1cr~6"1 ,....,.......___----1.1...1.t......lld<..Ll-"'U.l""'-""L.l.l.l.<"i..l.>.J..i:/ -comJ;l(b)(6) @lgmail.com!(b)(6) @gmai l.com] ; Bruce Moskowid -(b_)(_6l____ va .gov] ; Windom, John H.[John.Windom@va .gov]; DJS[vacodjs1@va .gov] ..... F~r o _m_:-- M-a-rc - S-he_r_m_a_n_~ ~ l§>mac.com]; Sent: Tue 3/ 13/2018 5:39:36 PM Subject: [EXTERNAL] Re: VA EHR NDA EHR NDA v2.pdf EHR NDA v2 mbs.pdf EHR NDA v2 RL.pdf Scott, l(bl(5 l land 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 adjust ments in red-line so yo u 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 version 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 appreciate your support and want to make sure we get to the best pl ace possible for Veterans, the country and taxpay ers. As we are incredib ly gratefu l to you for volunteerin g 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 tol~ (b_)(5_l__ ~kcc' d). 2) Matt will then send you the latest package under separate cover. 3) Given governm ent contracts are different than what you are used to reading, we would propose a quick phon e ca ll so that we can orient you to the contract and help foc us you on the parts where your expertise will be most valuable . l(b)(G) l(b)(6) l(who is the government contra cting officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask l(b)(6) (cc' d) here to help set up a time . We can either do this all together, if calendars mat ch up, or separat ely if need be. I I We have also connected with Stephanie Reel , Stan Huff , Dr. Kar son, Dr. Ko , Dr. Shretha , and Jon Mani s who all have all recei ved the NDA and we are working with them. I am hoping to connect with Dr. Coop er today. Thanks again! Scott VA-18-0298-I-000151 Page 1083 of 19i 1of 1380 [EXTERNAL) Re: VA EHR NOA (3).msg for Printed Item: 171 ( Attachment 5 of 8) Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veteran s Affairs VA-18-0298-I-000152 q5~of 1380 Page 1084 of 1 Document ID: 0.7.1705.452619 From: Sandoval, Camilo J. To: Spero , Casin D. ; Hayes-Byrd, Jacquelyn ; O'Rourke , Peter M. Cc: Bee: RE: Please Review Tonight Subject: Fri May 04 2018 02:12:35 EDT Date: [EXTERNAL] call today? (1).msg Attachments: [EXTERNAL] dod data sharing (2).msg Levin slide on DoD data sharing -octobe r 2017.pptx [EXTERNAL] extremely confidential - eyes only - please do not forward or share secva message this morning (3).msg [EXTERNAL] Fwd: amida weekly ehrm data migration update (4).msg Amida VA EHRM Weekly Report -sept 14 -final.docx [EXTERNAL] Re: call today? (5).msg EsaEmbeddedMsg (6).msg EsaEmbeddedMsg (7).msg FW: [External] connecting scott to charlie (8).msg FW: [EXTERNAL] dod data sharing (9).msg ATT00001.htm Levin slide on DoD data sharing -october 2017.pptx FW: [EXTERNAL] roger baker (10).msg RE: [EXTERNAL] check in (11).msg RE: [EXTERNAL] check in (12).msg RE: [External] connecting scott to charlie (13).msg RE: [EXTERNAL] extremely confidential - eyes only - please do not forward or share secva message this morning (14).msg RE: [EXTERNAL] follow -up from our last meeting (15).msg RE: [EXTERNAL] Fwd: meeting with rob on wednesday (16).msg RE: [EXTERNAL] stakeholder enterprise portal (sep) and ebenefits (17).msg RE: [EXTERNAL] susan perez (18).msg RE: RE: [EXTERNAL] thursday check in (19).msg RE: Schedule important: Jack Bates' Availab ility - Peter needs to re-schedule (20).msg RE: Schedule important: Jack Bates' Availability- Peter needs to re-schedule (21) .msg Windom (22).msg Pete- This request from members of congress is based on inaccurate reporting by Arthur Allen from Politico , which was fueled by David Shulkin and Scott Blackburn . In fact , the real outside interference and conflict of interest came from Peter Levin, who was attempting to shape the direction of ongoing contract negotiations between the VA and Gerner. According to John Windom and Ash Zenooz , on severa l occasions Secretary Shulkin suggested to the EHRM team that Peter Levin be hired as a direct VA-18-0298-I-000153 Page 1 of 2 15~of 1380 contractor. When those efforts failed, Peter Levin then acquired VA contracts through MITRE with Secretary Shulkin's influence. Please note that Peter Levin , Scott Gould, Stephen Ondra and Michele Flournoy (married to Scott Gould) all work for or are associated with AMIDA and MITRE. Ironically, they were all senior VA or DOD employees under the Obama administration with access to insider information. A key question Arthur Allen and interested members of congress should investigate and write about is, why did Shulkin and Blackburn continue to communicate with Peter Levin, and put undue pressure on John Windom to hire Peter Levin's firm-AMIDA-as a contractor. Also, why was Shulkin in such a rush to sign the Gerner contract last year(Oct/Nov) when there was over 51 major findings and recommendations added to the contract over the past several months? And for the record, it was a team of top medical CIOs and practitioners-put together by Ike Perlmutter and Bruce Moskowitz-who identified the flaws in the contract and made the recommendations, not MITRE. MITRE had advised against a strategic pause, and then took credit for the work done after. Please read attachments. From: Spero, Casin D. Sent: Thursday, May 03, 2018 7:31 PM To: Sandoval, Camilo J.; Hayes-Byrd, Jacquelyn; O'Rourke, Peter M. Subject: RE: Please Review Tonight Good info Cam, we may want to remind the interested parties of that. From: Sandoval, Camilo J. Sent: Thur sday, May 03, 2018 4:13 :22 PM To: Hayes-Byrd, Jacquelyn ; O'Rourke , Peter M.; Spero, Casin D. Subject: RE: Please Review Tonight Thank you Jacqu ie. If we go back to Shulkin's EHRM hearing testimony, he mentions under oath that he and Scott Blackburn requested outside, non-governmental help from the top 5 Medical CIO's. These experts are who alerted him to the many interoperability issues previously unknown to Gerner or VA staff. From: Hayes-Byrd , Jacquelyn Sent: Thursday, May 03, 2018 5:42 PM To: O'Rourke, Peter M.; Sandoval, Camilo J.; Spero, Casin D. Subject: Please Review Ton ight Please see these two documents tonight as the Dep Sec provided this to Colonel Gainey late this afternoon VA-18-0298-I-000154 Page 2 of 2 15~ of 1380 And Andy will be giving it to the Secretary first in the a.m. don't want you to be blindsided and I would like for you to be prepared to discuss. Jacquie From: Washington, Conrad Sent: Thursday, May 03, 2018 5:32 PM To: Hayes-Byrd, Jacquelyn Subject: REQUESTED SCAN Conrad Washington Special Assistant Office of the Secretary 810 Vermont Ave , NW Washington , DC 20420 202-461-7865 (0) Conrad. washington@va.gov VA Core Values: Integrity , Commitment , Advocacy , Respect , and Excellence-I CARE VA-18-0298-I-000155 Page 3 of 2 15~of 1380 Document ID: 0.7.1705.436459 From: Morris, Genevieve (OS/ONC/1O) l(b)(6) l@hhs.gov> To: Sandoval, Camilo J. Cc: Bee: Subject: [EXTERNAL] Fwd: 'Who the hell is this person?' Trump's Mar-a-Lago pal stymies VA project Date: Sun Apr 29 2018 17:28:38 EDT Attachments: From: "POLITICO Pro" Subject: 'Who the hell is this person?' Trump 's Mar-a-Lago pal stymies VA project Date: 29 April 2018 13:22 @hhs.gov> To : "Morris, Genevieve (OS/ONC/IO)' j(b)(6) 'Who the hell is this person?' Trump's Mar-a-Lago pal stymies VA project By Arthur Allen 04/29/2018 01 :15 PM EDT A West Palm Beach doctor's ties to Donald Trump's Mar-a-Lago social circle have enabled him to hold up the biggest health information technology project in history - the transformation of the VA's digital records system. Dr. Bruce Moskowitz, an internist and friend of Trump confidante Ike Perlmutter , who advises the president informally on vet issues , objected to the $16 billion VA project because he doesn't like the Cerner Corp. software he uses at two Florida hospitals, according to four former and current senior VA officials. Cerner technology is a cornerstone of the VA project. With the White House's approval , Moskowitz has been on two or three monthly calls since November with the contracting team responsible for implementing the 10-year project, according to two former senior VA officials. Perlmutter, the Marvel Entertainment chairman, has also been on some of the calls , they said. Many doctors and health IT experts are skeptical of the VA deal - especially after the problem -ridden implementation of a similar system at military hospitals . However , the involvement of Moskowitz and Perlmutter , which has not previously been reported, infuriated clinicians involved in the VA project, including former Secretary David Shulkin, according to one of the sources, a former senior VA official. Several officials said they thought contract negotiations had been wrapped up earlier this year and had no idea why the project was being held up. "Shulkin would say, "Who the hell is this person who practices medicine in Florida and has never run a health care system?" said the source. He said Moskowitz's involvement was one of the irritants in VA-18-0298-I-000156 Page 145 of 2 1~ of 1380 Shulkin's dealings with other White House-appointed officials , which contributed to his being fired March 28 . The behind-the-scenes talks , where Moskowitz questioned various aspects of the program , illustrate the degree to which members of Trump's circle have been able to influence government decisions, even about extraordinarily specialized subjects. That involvement has stupified policymakers, especially since members of Trump's family had pushed the opposite agenda : Trump's son-in-law, Jared Kushner , was instrumental in Shulkin's June 2017 decision to choose the Gerner Corp . system with a no-bid contract. Shulkin announced the Gerner deal after severa l White House meetings with Kushner and aides from his Office of American Innovation. But Moskowitz's concerns effectively delayed the agreement for months, the sources said. VA spokesman Curt Cashour said Wednesday that finalizing a decision on the modernization of the VA's health record system was a priority for acting Secretary Robert Wilk ie. Cashour didn't respond specifically to questions about Moskowitz's role. "Proper due diligence is required to ensure the best interests of veterans and taxpayers are served before the department enters into any agreement of this size and importance," he said. "We are doing that now, and expect to make a fina l decision and corresponding announcement ... in the coming weeks." Shulkin declined to comment for this story, as did Gerner Corp. Moskowitz and the White House did not respond to requests for comment. Moskowitz , trained in medicine at the University of Miami, is a beloved West Palm Beach physician who sits on medical nonprofit boards with billionaires . He has invested in projects like an iPhone app to help patients find emergency care and a registry to track medical-device safety issues . Moskowitz also has "a great Rolodex ," in the words of one VA official, with many contacts at top-rank facilities such as the Mayo Clinic - where he sends his patients for specialty care. In December 2016, he and Perlmutter helped broker a Mar-a-Lago meeting between Trump and leading health care executives from Mayo , the Johns Hopkins University Hospital , the Cleveland Clinic and other big systems. Perlmutter , meanwhi le, has been advising Trump on veterans affairs since before the inauguration. Some news reports say the Israeli-born businessman's interest in veterans stems from serving in the Six-Day War of 1967. While Moskowitz' complaints about the software he's used in Florida are not unusual , IT specialists at the VA felt that he was out of his league in evaluating the Gerner deal. After listening to his complaints, a team of investigators from VA's Office of Information and Technology looked into the Gerner system that Moskowitz uses at two Tenet Corp . hospitals in Florida and found that it was out of date , two sources said. Yet Moskowitz assumed that if his hospitals lacked a feature , it meant that Gerner could not produce it for the VA, they said. "'He'd be, like, 'It doesn't' have voice-recognition software.' Yes, Gerner does have voice-recognition software. But it isn't installed in all Gerner hospitals ." "This was part of the rub between Shulkin and the Trump people," the first source said. "This guy's whispering in Trump's ear , 'I know because I have to use it!"' Shulkin's June 2017 decision to jettison its home-grown digital records systems was controversial from the start . Many VA physicians rate the VA system highly, but Shulkin decided it would be best to use the same Gerner software system the military had chosen in 2015 so that records cou ld be more easily VA-18-0298-I-000157 Page 146 of 2 15~of 1380 shared. The military has experienced numerous glitches since implementing the Cerner software at four Washington state clinics and hospitals last year, however. At a hearing Thursday , Sen. Patty Murray said these problems have had a "significant morale impact on the practitioners in my state , not to mention serious concerns about putting patients' lives at risk." Stacy Cummings, who runs the project for the military, testified that despite the challenges, the implementation is on track to finish nationwide in 2022 . The VA is moving forward with its plan to use the same Cerner system "as far as I know," she added. Many health care and technology leaders view the combined VA-DoD Cerner project as a crucible for the future of computerized health care in the United States. Kushner hosted at least four White House meetings from December through February at which the project was centra l to discussions. VA officials were aware of the potential pitfalls. Last fall, Shulkin postponed signing the final agreement while seeking assurance that the Cerner software could enable health data exchange with private sector doctors who see veterans. But the contract appea red to be back on track in January after delivery of an independent report Shulkin commissioned to review the issue. "I thought it was going to be done in a few days after that ," said a congressional source who tracks the deal. "Now it looks like there isn't any tangible path forward ." In a related move , an individual with ties to Trump-appointed VA officials said this week that an inspector-general's report had been opened into the Cerner sole-source purchase . Several IT experts consulted on this story said they thought the Cerner deal eventually would go through. Most said it would not be realistic to expect officials to renegotiate the contract or ditch it to stay with the VA's internal software system. "We just had to make the Mar-a-Lago guys comfortable with the deal ," said a current VA official. "They have someone's ear. Power and influence are power and influence ." To view online: https ://www.politicopro.com/defense/article/2018/04/doctor-with-mar-a-lago-connections-delays-g va-project-508297 iant- Was this Pro content helpful? Tell us what you think in one click. Yes , very Somewhat Neutral Not really VA-18-0298-I-000158 Page 147 of 2 15~of 1380 Not at all You received this POLITICO Pro content because your customized settings include: Health Care: Health IT. To change your alert settings, please go to https://www.politicopro.com/settings This email was sent to genevieve.morris@hhs.gov by: POLITICO, LLC 1000 Wilson Blvd. Arlington, VA, 22209, USA VA-18-0298-I-000159 Page 148 of 2 15~of 1380 Document ID: 0.7.1705.436432 Bruce Moskowitz From: @mac.com> Sandoval, Camilo J. Stephanie Reel l(b)(6) @jhu.edu> l(b)(6) To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Re: OIT Leadership Sun Apr 29 2018 13:37:48 EDT I have copied the smartest CIO I have met. Perhaps she can find time for you to meet her at Hopkins. Sent from my iPad Bruce Moskowitz M.D. On Apr 28, 2018, at 11 :56 PM, Sandoval, Camilo J. wrote: Bruce- Last week I officially began leading the Office of Information & Technology as the Executive-in -Charge (CIO) for the VA until a permanent CIO is nominated and confirmed through the Senate process , which could take 3-6 months or longer. As I familiarize myself with the complex IT operations and large distributed teams (16,000 employees), I am also surrounding myself with a small group of Federa l CIO' s that can advise me on interagency cross-over issues and policies . I would love to find a private sector CIO (1-or-2) with healthcare IT experience that could advise me on enterprise-wide IT infrastructure and operation services. I am very interested in identifying areas where best practices from the private sector can be applied to enhance the customer experience , and improve support to veterans. As a Veteran myself, this mission is very personal (see note to my team below) , especially during this pivotal stage of EHRM modernization . I know you are well connected to the brightest in the field , and I would welcome an introduction to anyone you think might be open to this idea. Here's a link to my VA bio. Feel free to share with anyone. Thanks again for everything you do , I greatly appreciate it! https ://www.va.gov/opa/bios/bio _sand oval .asp VA-18-0298-I-000160 Page 149 of 211iof 1380 Camilo Sandoval M :l(b)(6) From: Sandoval , Camilo J. Sent: Monday, April 23 , 2018 10:52 AM Subject: OIT Leadership Good morning, I don't think I've had an opportun ity to meet everyone on the OIT Leadership team, but I hope to meet all of you very soon. I am sending a brief note to share where I stand right now. My first priority is to meet and spend more time with all of you , as I view this as an opportunity for honest , earnest , two-way communication. I will do a great deal of listening so I can understand historical perspectives about OIT and our priorities. You were here before me . You have viewpoints and personal experiences that I don ' t. Please share them . I want to learn everything I can about the current culture and what inspires your teams as quickly as possible. I also want to peel back the onion and dive into the details . You can help me with the backg round on our performance, plans/strategy and decision-making processes . I want to understand what works , what doesn 't and where we might have opportunities to improve . Over the weekend I reviewed the Comprehensive IT Plan and 2017 Year in Review transformation/modernization documents. I have to say , there's a lot of good work and progress that I hope you are all very proud of . I love to see this kind of optimism and innovation. It's healthy . It's contagious . It inspires pride . I am humbled and proud to lead a team that impacts our Veterans in every way imaginable. For me, technology does not respect tradition- it respects innovation ; and we are in a pivotal time . Make no mistake , we are headed for greater places - as technology evolves and we at the VA evolve with or ahead of it. I am here for the same reason I think most people join OIT - to change the way we serve our Veterans by harnessing the power of technology . We live in a software & data powered world , and we have an unparalleled capability to make an impact. In some cases , we'll apply the brakes. In other instances , we may hit the accelerator. In every case , we must provide clarity to our customers, to our workforce, and most importantly to our cherished Veterans. Let's build on this foundation together. I'm ready to get started. Thank you , VA-18-0298-I-000161 Page 150 of 2 11~of 1380 Cam ilo Sandoval Executive-In-C harge Office of Information & Technology U.S. Department of Veterans Affairs Washington , D.C. M :l(b)(6) VA-18-0298-I-000162 Page 151 of 2 11~of 1380 Document ID: 0.7.1705.436212 From: Sandoval, Camilo J. To: Bruce Moskowitz l(b)( 6 ) l@mac .com> Cc: l(b)(6) @gmail.com l(b)(6) @gma il.com> Bee: FW: OIT Leader ship Subject: Sat Apr 28 2018 23:56:05 EDT Date: image002.png Attachments: Bruce- Last week I officially began leading the Office of Information & Technology as the Executive-in-Charge (CIO) for the VA until a permanent CIO is nominated and confirmed through the Senate process, which cou ld take 3-6 months or longer. As I familiarize myself with the comp lex IT operations and large distributed teams (16,000 employees), I am also surrounding myself with a small group of Federa l CIO ' s that can advise me on interagency cross-over issues and policies . I would love to find a private sector CIO (1-or-2) with healthcare IT experience that cou ld advise me on enterprise-wide IT infrastructure and ope rati on services. I am very interested in identify ing areas where best practices from the private sector can be applied to enhance the customer experience, and improve support to veterans. As a Veteran myself , this mission is very persona l (see note to my team below) , especially during this pivotal stage of EHRM modernization . I know you are well connected to the brightest in the field , and I would welcome an introduction to anyone you think might be open to this idea . Here's a link to my VA bio. Feel free to share with anyone. Thanks again for everything you do , I great ly appreciate it! https ://www.va.gov/opa/bios/bio _sa ndoval .asp Camilo Sandoval M :l(b)(6) From: Sandoval , Camilo J. Sent: Monday, April 23, 2018 10:52 AM VA-18-0298-I-000163 Page 152 of 2 11~of 1380 Subject: OIT Leadership Good morning, I don't think I've had an opportunity to meet everyone on the OIT Leadership team , but I hope to meet all of you very soon. I am sending a brief note to share where I stand right now . My first priority is to meet and spend more time with all of you , as I view this as an opportunity for honest , earnest , two-way communication. I will do a great deal of listening so I can understand historical perspectives about OIT and our priorities . You were here before me . You have viewpoints and personal experiences that I don ' t. Please share them. I want to learn everything I can about the current culture and what inspires your teams as quickly as possible. I also want to peel back the onion and dive into the details. You can help me with the background on our performance, plans/strategy and decision-making processes . I want to understand what works , what doesn 't and where we might have opportunities to improve . Over the weekend I reviewed the Comprehensive IT Plan and 2017 Year in Review transformation/modern ization documents. I have to say , there's a lot of good work and progress that I hope you are all very proud of. I love to see this kind of opt imism and innovation. It's healthy . It's contagious . It inspires pride . I am humbled and proud to lead a team that impacts our Veterans in every way imaginable . For me, technology does not respect tradition - it respects innovation ; and we are in a pivotal time . Make no mistake, we are headed for greater places - as technology evolves and we at the VA evolve with or ahead of it. I am here for the same reason I think most people join OIT - to change the way we serve our Veterans by harnessing the power of technology. We live in a software & data powered world , and we have an unparalleled capability to make an impact. In some cases , we 'll apply the brakes. In other instances , we may hit the accelerator. In every case, we must provide clarity to our customers, to our workforce, and most importantly to our cherished Veterans. Let's build on this foundation together . I'm ready to get started . Thank you, VA-18-0298-I-000164 Page 153 of 2 of 1380 1e~ Camilo Sandoval Executive-In -Charge Office of Information & Technology U.S. Department of Veterans Affairs Washington , D.C . M: l(b)(6) VA-18-0298-I-000165 Page 154 of 2 11~of 1380 Document ID: 0.7.1705.535223-000002 Owner : Blackburn , Scott R. Filename: [EXTERNAL] Fwd: Contact review (2).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000166 Page 191 of 2 18~of 1380 To:[EXTER~hl_l~~.n!38B"ftv~,s86W!l:lf~ellrJurRtdRtl~~ Item:215 ( Attac hmen t 2 of 27) From: David Shulkin Sun 3/ 11/2018 4:31 :54 PM Subject: [EXTERNAL] Fwd: Contact review Sent: Scott let s di scu ss tommorow Sent from m y iPhon e Be gin forwarded me ssage: From: David Shulkin l(b)(6) l@gmail.co m> Date: Mar ch 11, 2018 at 12 :31:22 PM EDT To: Bruce Mo skowit z (b)(6) mac.com> .-------. Cc : IP Cb><5> fre nchan Le..:..1 5:.... 9:..... c_o_m_> _ ,..,, (:-:b )-:-: (6:-:-)-----'f ==m=a= il=.c=om,l(b)(G) Subjec : @gma il.co m e: Contact review Great list Is leslie cooper from m ayo- i could not find him or her Sent from my iPhon e On Mar 11, 2018, at 11 :02 AM , Bruc e Mo skowit z l(b)(6) @mac.com> wrote: The se are the individua ls to revi ew the contract ; Stephanie Reel CIO - hopkin s Stan Huff CIO- intermiuntain Jonathan Mani sCIO- suttrr Andr ew Kar son MD. - partn ers Leslie Coop er M.D. Clifford Ko M.D .- am erican colle ge surg eon s Sent from my iPad Bruc e Mo skowit z M.D . VA-18-0298-I-000167 Page 192 of 2~1~ of 1380 Document ID: 0.7.1705.535223-000004 Owner : Blackburn , Scott R. Filename: [EXTERNAL] RE: VA EHR (4).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000168 Page 195 of 2 of 1380 1e~ To:[EXTERtfi~Jl&i ,vttffimd Cc : From: Sent: Subject : 1¥_eigc3r3m I (b)(6) (b)(6) f-'b....;..;_6 -'-----------,----------------' Mon 2/12/2018 7 :54 :08 PM [EXTERNAL] RE: VA EHR Scott, (b)( 5) Please let me know if you have additional questions. Thanks! Jane l(b)(6) Office of the White House Counsel (202) 456-6980 l(b)(6) From : Liddell , Christopher P. EOP/WHO Se nt : Monday , Februar y 12, 20 18 2:37 PM To: Blackburn, Scott R. Cc: (b)(6) Subject: RE: VAEHR Scott I discussed this with Jane ( copied here) Thanks Chris From: Liddell, Christopher P. EOP/WHO Sen t: Monday, February 12, 2018 9:31 AM To: 'Blackburn , Scott R.' Cc (b)(6) Subject: RE: VAEHR Scott Sorry for slow reply - happy to catch up at so me stage this week Chris VA-18-0298-I-000169 Page 196 of 2~1i of 1380 [EXTERNAL) RE: VA EHR (4).msg for Printed Item: 215 ( Attach ment 4 of 27) From: Blackbum, Scott R. [mailto:Scott .Blackbum @va.gov] Sent: Thursday, Febru ary 8, 2018 9:41,.... P.... M "-'--------~ To: Lidde ll, Christopher P. EOP/W HO ~(b)(G) Subject: VAEHR r«vwho.eop.gov> Chris If you have time possib ly early next week, I wo uld love to ge t your advice re late d to our EHR. The next few weeks will be critical (with budget hearings, discussions with appropr iator s, Vetera n Service Organizations, etc) and we want to make sure we handle everything ap propr iately. If you are open to it, I can work wittt(b)(6) ~o find time. Also, I have att ached th e Executive Summa ry of MITRE's VAinteroperability repor t. Overall very consistent with everything else we see m to be hearing. Scott Scott Blackbum Executive in Charge, Office of Informatio n & Technology US Departm e nt of Vetera ns Affairs VA-18-0298-I-000170 Page 197 of 2~% of 1380 Document ID: 0.7.1705.535223-000007 Owner : Blackburn , Scott R. Filename: Follow up (7).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000171 Page 202 of 2 17~of 1380 Toto llowupg~cffi~l'i7f8H ~8Wlfz~l (b_)(6 _)____ From: Blackburn, Scott R. Se nt: Wed 11/22/2017 11 :49:19 PM Subject: Follow up ~~~~-b8htJ;~ ~(b_)(6_) _~ ~gmai l.co~ ~(b_)(6_) _~ @gmai l.com] Bruce/ Marc - thanks again for all your support. We really appreciate what you are doing to bring the best of the healthcare industry to help Veterans/VA. I spoke with David and he gave th e gree n light to move forward. We absolutely want to get this feedback and greatly appreciate th e help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we need to figure out with respect to timing on signing the con tra ct with Congress/budget/funding/etc (e.g., one of the reasons for starting soon is to get in sync with DoD's rollout to leverage synergies; another variable is the Continuing Resolution and timing of when the governme nt budget is finalized which could po ssibly push out to Jan/Feb rather than December as current ly projected ). But we will figure that out. The point being is that we love the idea, do want the feedback, and agree with the logic we discussed on the ph one. We will delay the signing as long as we can to make sure we get this right (the concern is making sure we don't miss the window). If you could rea ch out to the 5 CEOs/CIOs, it would be grea tly appreciated. I will commit to making sure the VAturns around the gap analysis as fast as possible . Do you think it could then be po ssible to shoot for a full da y session in mid-December (week of 11th or I 8th )? David had the idea of possibly doing it at the Cerner Innovation Laboratory in Kansas City so we can test/challenge somet hings on the spot. Thanks again for all your support ! I hope you and your families have a grea t Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in -Charge, Office of Informat ion & Tech nology Department of Vete ran s Affairs VA-18-0298-I-000172 Page 203 of 2~~ of 1380 To: RE:[EXTB'm~lrt:ffl~d&i (b)(6) Cc : !/b)(6) tpgm~a~1 _c;c ~o-:-:r:;: (b:-;)(;;::6-:) ---;;;g From: Blackburn, Scott R. Sent: Mon 11/27/2017 3:42:51 PM Subject : RE: [EXTERNAL] Follow up meeting rWat ~~ 8IBfem: 215 ( Attachment 12 of 27) mail.com] Thank you Bruce . Very help ful. From: Bruce Moskowitz_(b_ l )(_6_ ) -------~ ka?mac.com ] Sen t: Monday, November 27, 2017 10:18 AM To: Blackbum, Scott R. Cc:l(b)(6) @gmail.com S ubj ect : Fwd: [EXTERNAL] Followup meeting I should point out thi s wou ld be ideal functionality req uirement s of any EMR contract if not part of what has been reviewed by the VA we need to discuss the se points further since they are der ive d from the previous meeting point s made by the CIO' s and we can again cover them in the agenda Sent from my iPad Bru ce Moskow itz M.D. Begin forwarded message: From: Bru ce Mo skowit z J(b)(6) rvmac.com> Date : November 27, 2017 at 8 :4 lL:1;..;.9,....:A,....M....,.....E ....S,..,, .... 1--____r --==~~ To: "B lackb um, Scott R."< Scott.Blackbum@va .gov> Cc: l(b)(6) k@gmail.com" l(b)(6) t@gmail.com> Subject: Re : [EXTERN AL] Follow up meeting Prior to any meetin g we need to know what is not in the co ntract so we can mak e pro gress : Cemer Contract has to ha ve the responsib ility of 100% connectivity to all EMR platform s for Choice to work Cemer has to have telemed icine built into th e sys tem Cemer needs to tract duplicate diagnost ic te sting Ce m er needs to have medication error, tracki ng of contro lled substan ces and dupli ca te presc ription monitorin g Cemer needs to tract appointment times between the VA and the Choice Program. Ce m er needs to have voice recog nition buil t in The se are the basics we need to know prior to writing an agenda and meeting. Thank yo u Sent from my iPad Bruc e Mo skow itz M.D. On Nov 26, 2017 , at 9:23 AM, Bl ackb urn , Scott R . wrote: Bru ce - thank s for the note. I hop e you and M arc both had a great Thanksg iving. Sounds good on all below. Let's shoot for the week of De cemb er 11th or December 18th in VA-18-0298-I-000173 Wash ington. If the CI Os can get us the list of issues by Dece mber 5th, we will tum aro und the gap analys is quickly. Happy to work with Step han ie, Andr ew and M arc on the age nda P f age 218 O 2318 173 of 1380 RE: [EXTERNAJ..lFoUowup mee ting (10) .msg f$x.tracted> tor P1int13dllt em: 215 ( Attachment 12 of 27) cteve lopment - tl1at woma be very ne1pru . Scott -----Ori ginal Message- ---~----------~ From: Bruce Moskow itzl(b)(S) Sent: Friday, November 24, 2017 7:08 PM To: Blackbum , Scott R. Cc: l(b)(6) ~gm ail.com Subject: [EXTERNAL] Follow up meeting @mac.com ] I am speaking for myself and it wou ld seem to me that holding it at Cern er wou ld restrain an open honest discussion of what is needed to insure that we have all the key pieces to ha ve the the EMR that we all see as a necessity to provide the end users with all tools necessary to provide quality care. The five CIO ' s are very know ledgeable regarding all capabilities of Cemer. I have been an end user of Cemer and know as do the CEO 's the process to quick ly move the agenda forward . We are committed to your adoption of Cerner as the EMR how ever being rushed into a contract without due diligence on our part would be prob lematic. We can be availab le for a meeting in Washington ASAP full y realizing some will need to be on a conference call. I would recommend an agenda that reflects the way forward by both group s and would recommend you allow Step hanie Reel,Andr ew Karson and Marc Sherman to assist in the agenda development. Sent from my iPad Bruce Moskow itz M .D. VA-18-0298-I-000174 Page 219 of 2~1/! of 1380 Document ID: 0.7.1705.535223-000013 Owner: Blackburn, Scott R. Filename: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu (11 ).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000175 Page 220 of 2 17~of 1380 ~ [E XTEf_mtbla~i&g,~~Pc~r/lWtWM1lr)(6),, ,) 1p~fM\il-AA~ tkl wrote: Bruce - as promised here is more information on what we will have to address the othe r 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 Cemer EHRplatform 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 VAMedical Center uses it). Cemer will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cemer 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. l. Worktlow MPage lab Component and 2. Results review tlowsheet. When outside labs are mapped we wou ld use the same names as internal and then they would appea r 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 VAwould 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 test s at their initial three sites that have been implemented. Strea mlined SOAP notes. Yes, the VA/Cemer system will have this. These are provided and will be further configured under VAdirection to meet VAclinician needs. From: Blackburn , Scott R. Sent: Wedne sday , February 28, 2018 2:30 PM To: 'Bruce Moskowi tz' pj?gmail.com Cc : DJS; Marc Sherman; O'Rourke, Peter M.; IPd{b )(G) Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + lan guge + 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. VA-18-0298-I-000176 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 f!iMe 221 of 2318 176 of 1380 h negot1atron. Let me sen you the specmcs wnere we-nave 1anoeo to make sure that we got them t1g t. Stand by ... Re: [EXTERNAL] Re: Open API - it isa CLOUD + langu(le. + Ra~ / 11).msg, 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 pushback. A few things I learned this mornin g ... The contract does NOT lock us in to Amazon Web Services (AWS). Rather any cloud provider or applications that meet sec urity and privacy requirements to protect Veteran data can interface with Open AP!s or push data to the VA/Cerner system. Currently 3 cloud providers meet the Government sec urity requirement s - AWS, Azure/Microsoft and CSRA. There are severa l others that we expect to come on board soo n 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 sta ndards (these standards are dictated by GSA, not VA). Cerner does have a partner ship with AWS (which is why we highlighted that) but it is just one example of the open could environments they are plannin g to work with. We have confirmed that it will be OPEN and not propri etary to their specific AWS cloud. DoD is excited to follow our lead on all of this. I spe nt the morning at the Pentagon with the DoD CIO/team. This will help not just Veterans, but service member s still in uniform. Thanks again for the feedback and support. We are going to make sure this is crystal clear. Scott From: Bruce Moskowitz!(b)(6) l@mac.com] Sent: Tue sday , February 27, 2018 9:29 PM To: Blackbum, Scott R. Cc: DJS; Marc She rman; O'Rourke, Peter M.; IP; l(b)(6) Subject: VA-18-0298-I-000177 la> gmail.com [EXTERNAL) Re: Open API - it is CLOUD + lan guge + Rasu Page 222 of 2~117 of 1380 Document ID: 0.7.1705.535223-000014 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] Re: VA EHR (12).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000178 Page 226 of 2 17~of 1380 1 To:RE: [EXTB~~.V~cfbtr~ .f$~8t1t~!'Nek~S?rl~~~~~SJr,13aJJM&r1f~'TVMAAJt['l'tt6lnas.Bowman@va .gov] Cc: Zenooz, Ashwini[Ashwini.Zenooz@va.gov] ; Short , John (VACO)[Joh n.Short@va.gov ] From: Windom, John H. Sent: Fri 3/23/2018 5:54:36 PM Subject : RE: [EXTERNAL] Re: VA EHR Mr. Blackbum, I went ba ck and re ad Mr. Sherman 's emai l and review ed my notes. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sand box/ tes t platform in advance of contract award. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Moderni za tion (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washin gton , DC 20420 John. Windom@va .gov Office: (202) 461-5820 Mobile 1= (b'"'") ("'"6)'-------' ,......,.........,........., Assistant: Ms. l~ (b-)(-6)-~I - Appointments and Scheduling va.oov Office: 202-382-3792 From: Windom, John H. Sent: Friday, March 23, 2018 1:47 PM To: Blackbu rn , Scott R.; Bowm an, Thoma s Cc: Zenooz, Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] Re: VA EHR Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type . We have provisions in the EHR contract to insert technology as we, the VA, as well as to incorporate evolving technology and standards. The DVPacquisition is our bridge to the use of APis (gateways), FHIR,etc . We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the rece nt phone call to sto p Marc Sherman, et. Al's parade of nation al interoperability objectives as not feasible at this juncture "a nywher e," but included as part of our overall interoperability strategy that includes the DVPacquisition/strategy. We are committed to establishing the interoperabilit y test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition , I belie ve Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman do es not understand the culture of VAor the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHR Modernization effort. He appears to be more of a "big bang " theor y guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulation s/policies (e.g. cybersecurity, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology , innovation opportunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities (IOC)process and the judicious issuan ce of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to reco gnize that it is Program Management Oversight (PMO) and VA commitment to change mana gement that will drive our success in these areas, not mor e words in the contract. VA-18-0298-I-000179 V/r , John Page 227 of 2~¼ of 1380 l;U;:JEKT.EBI\IAL l Re; VA EHR /12).mso fo,rP.rinted Item : 215 (Attachment 14 of 27) ID 1v PWl'i 5.5.l. worktlow uevernpm e nt ano No rma11z at1on. j) The Contractor shall enable configuration of the application that supp orts external communi ty data without requiri ng the clinician to go to specia l scree ns to see and use reconci led exte rnal data . By IOCentr y, the Contractor shall support incorporation of the following external comm unity data domain s, including but not limited to these domains and sub-domain s: • Problem s • Allergies • Home Medications • Procedure s - including associa ted reports and with appropria tely filter ed CPTcodes • Immuni zations • Discharge Summaries • Progress Notes • Consult Notes • Histor y & Physicals • Operative Note s • Radiology and Diagnostic Report s (Into "Documentation " component) By IOCexit, the Contractor shall suppor t incorporation of the following external community data domains , including but not limited to th ese domai ns and sub-domain s: • Res ults o Labs - General - Patho logy and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report " component ) • Images IDIQPWS Sectio n 5.10.4: Seamles s Interoperability/ Joint Industry Outrea ch includes significant detail on the topic. The interop erability section is copied below this table for referen ce. IDIQ PWS section 5.5.4 Data Exchange - Application Program Interfa ce (API) Gateway also includes detail on the crea tion of stra tegic open APis. VA NF-177: Interoperability - Data Standards: The system shall support the use of the health data stan dards identified in the VA DoD Health Information Technical Standar ds Profile and by th e VA DoD Intera gency ClinicalInformatic s board, including following common data standa rds: National Inform ation Exchan ge Model NTEM;Healt h Level 7 HL7; Logical Observation Identifier s, Names and Codes LOINC; Systema tized Nomenclature of Medicine SNOMED;RxNorm, MedRT, ICD,CPT,HCPCS,Vetera n Information Model VIM;and Healthca re Informati on Technology Standard s Panel HITSP as well as VA/DOD/IPO exten sions to the se standard s. VA-NF-T23: Inform at ics - Care Integrat ion : VAmust be able to se amlessly integrat e with HIEand external-to-EHR shared services to provide for a seamless experie nce and to more effectively integrate in community care efforts, as well as with other part s of VA (e.g., identity mana gement). This includes but is not limited to the EHRprodu ct ability to support externa l shared services (SOA services, such as identit y management, care plan service, scheduling, etc.) acce ssed via sta ndards-based APis. (Process Continuity, Evolution , Extension) KSR5 [NOW+) VA NF-Zll: Health Information Exchange : The system shall support VAelectronic exchange of health records via other interoperable networks (e.g. CareQuality, Common Well Health Alliance, DirectTrust, National Association for Trusted Exchan ge) by suppo rting th eir specification s, security and content specifications 5.10.4 Seam less Inte roper ab ility/ Joint Indust ry Outreach The Contractor is requ ired to collabora te with VAaffiliates, communit y par tn ers, EHR pro viders, healthcar e pro viders, and vendor s to pro vider market. Seamless care will require the creation of an inte grat ed inpatient and outpati ent solution with softwar e compon en1 and deployed with a de sign architecture that allows for access to and sharing of commo n data and an enabling security framework th VA-18-0298-I-000180 and busine ss operations. Seamless care is the experience patient s and pro viders have moving from task to ta sk and encoun ter to enc high-qua lity decisions form easily and comp lete care plan s execu te smoothly. Information system s support the seamless -care experie information , and managing tasks. Currently, industry lacks specific and uniform inte roperability standard s t~~Sfflmlm s care be v• -'1'80 of 1380 RE: IEXTE B.NAU Re: VA EHR / 12Lmsq for Printed Item; 215 ( Attaphmenb14 of 27\ . . . . . etc., to the ex rent such extensions are consistent with tne mode ano est practice s of the controlling national standard. This include knowledge with clinical partners. This fosters rapid adoption from industry be st practices, e.g., clinical profe ssional societies. 5.10.4.1 Data Desi gn and Information Sharing In support of the interoperability objectives under this Section, agreed upon Contractor proprietary information/data model exte nsio provided to both international and national standards des igna ting organizations as describe d and se t forth in an applicable Task Orde right s into any underlying proprietary terminolog y/code systems for the purpose of enhancing national standard s to address any gapi shall also make the interoperability capabilities and product enhancements developed under this contract available to non -VACerner 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VAanticipates developing a Digital Health Platform/Di gital Veterans Platform (DVP)to consolidate critical VAEHRand non-EHR opera EHRMto interoperate with DVP,or future state VAplatform, including the DVPAPI gateway or any other method de signated by VA. John H. Windom, Senior Executive Service (SES) Program Executive for Elec tron ic Hea lth Record Modern ization (PEO EHRM) Special Advisor to the Under Secreta ry for Health 81 1 Vermon t Avenue NW (5th Floor Suite 5080) Washington, DC20420 John.Windom@ va.go v Office: (202) 46 1-5820 Mobile: !(b)/6) Executive Assistan t: Ms. (b)(S) Appointmen ts and Scheduling l(b)(6) ~ va.go v Office: 202-382-3792 I 1- From: Blackburn, Scott R. Sent: Friday, March 23, 2018 12: 15 PM To: Windom, John H.; Bowman, Thoma s Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary/Deputy's office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good. com) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackbum, Scott R. Cc: Bruce Moskowitz; DJS Subject : [EXTERNAL] Re: VA EHR Scott , VA-18-0298-I-000182 Than ks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. Page 230 of of 1380 2~1~ RE: fEXTERNAl.,l Re: VA EHR /.] 2lJJ1sg_feKtracte,.1>f{)r P.rinted Item: 215.1Attachment 14 of 2.7) , , I reaa carerur1yyour ema1 aoou me enons to worK out me no1es ra1sea oy the experts. You are on the way to k1ck1ngoff an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard; and I know everyone has the goal to bui ld the best next generation system for the veterans' healthcare . However , there were several major issues raised in the calls this week with the technica l and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts . These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer, but I respectful ly don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them. The experts are recommending a system for the VA that has various enhancements to today's standard system functiona lity. At a minimum, I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non-standard) functiona lity (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose. The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingred ient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous. You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe . However , when you substitute this concept for clear, written and defined functiona lity, especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions , but the experts are so united on this point; and together with my historical observations of failures in nearly identica l situations I just see warning flares going off. Scott, I want to see this project get started , and qu ickly, as much as anyone, but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Jus t my opinion and food for thought as you make your decisions. Marc On Wed, Mar 2 1, 20 18 at 10:19 PM , Blackburn , Scott R. wrote: Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VAOpen APIPledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at Intennountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIRAPis for VAin support of this contract. This will also benefit Intermountain as Stan was telling us they've only had I 0-15 for their entire company to date. If VA/DoD/Intermountain work together we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000183 Per Stephanie 's suggestion, we are going to start moving forward ASAPon formalizing an Advisc,rM~ffi iof%~~ that -'f 83 of 1380 RE: [EXTERNAL ] Re· VA EH R / 12).!TISQ for Pr igted. lterp; 215 ( Attachrmm t 14 .o.f 2Z) . . . . we can get these 1ns1gmson an ongoing as,s. t'ormalmng tn,s will allow for contmmty of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo), Will Morris or Ed Marx (Cleveland Clinic),Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established durin g our Initial Operating Capabilities (IOC)implementation/deployment process to solidify the req uisite interoperability requirement s prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearin g from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and crosswalking this against the language in th e RFP/contract documents (both EHRand also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feed back, we feel very good that we have a solid contract from which we willjust need to make minor revisions. After discussing this with Secretary Shulkin toda y, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP(we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIOcontract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then ha ve the funding and authority to do so - and Secretary Shulkin could sign as early as next week. If the Omnibus falls through (which let's hope not), then we would have to request a tran sfer from the Congressional appropriation committees which will then take -2 weeks. Signing the initial task orders will allow us to star t moving forward with Cerner on the initial 3 hospitals (which will be in Washington state ) on thin gs like site surveys, infrastructure readiness, data hosting, change management (with will include wide involveme nt from clinicians inside and outside VA...somet hing we heard loud and clear from Bruce!), help de sk establishment, and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQstructure of the contract we would not be signing the full contract (rather just Year 1 - which is -5% of the value of the contract ). But this will allow us to get moving and out of the "quicksand" . Marc makes a great point below on turning DoD's stru ggles into a positive. We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am ther e so much; John and I work very closely with their EHRlead Stacy Cummings; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers). We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This under scores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more). This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be I00% driven out of any tran sformation of th is magnitude. Stephanie Reel so succinctly captured, "it is the oversight and mana gement of the contract that will be of the utmo st importance, as well as the VA'Saccess to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definit ely going to need all the help we can get. Again, we believe the const ruct of the contra ct, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concern s, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall VA-18-0298-I-000184 care. Interoperability remains at the forefront or our concerns, and your comments, the MITREstudy and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interopera bility will be a mo ving tar get for years to come, but our contract allows us to leverage the be st of ideas of industry throu ghout the contract's PttgW~0!24:J:f iBmnr in_g 184 oT1380 1 th~E~I~~bTt~~t ~JlsEh V1o't~ a~~Rlf8cf€ar~:e1s te~11r~t egJ t Bibt~~~'61yp~t1'h~Ltn~ antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently, you have been tremendous "demanding partner s" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott From: Marc Sherman l(b)(6) rPgmail.com ] Sent: Wedn es da y, March 21, 2018 9:31 AM To: Blackbum, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re : Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussio n and thought I would offer some reaction/feedback that still seems un settled. I will outline my nighttime thou ght s below in case you find them use ful. 1. I thought that Dr. Cooper made a goo d case for inserting specific definition s and standards on the meaning and use of "interoperability, " especially since that term ha s a s man y meanings in the indu stry as tho se who speak it. It is so easy for the contractor to proceed down a de sign path using one definition or standard while the use rs will require a totally different standard. That run s the ri sk of not being discovere d until later, p er hap s even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the use r s are rebelling. Unfortunately, if thi s "gap " in definition is not di sco vere d until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not se t the critical definition s and standard s in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividend s later in term s of le ss ar gument s, better initial de sign, happier use r community, less overall cost, bett er healthcare delivery, etc. Then, with th e standard fully defin ed and se t in the original PWS, the mock-up te st will be much sooner in time and much more complete the fir st time, allowing the use rs to provide input sooner and better , eliminating costly de sign mi stakes from the be ginnin g. The use r co mmunity can tell you today what is needed to accomplish thi s "next generation " system that will be a model for th e co untry and the future of healthcare (as Ms. Reel envisioned on the call la st night). Why would you not want to tell the contractor the spe cific s of that now, in fairnes s to them , the VA, the patient s and hea lthcare, so th ey ca n pro cee d with that standard from day one or express any concern s they may have now instead of in th e future after co stly de sign ha s occurred? Why would you not want to be spec ific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I be liev e he sa id sec tion 5 .1. 1) of the PWS. Dr. Cooper, as a ph ysician user and no t a t ec hnician, deferr e d on th e effectivene ss of the existing contract lan guage to others, but commen ted that the CIO of MAYO read the contract and also did not think it adequatel y contained the righ t definin g langua ge to se t out unambi guo us defin ition s and standard. I ha ve read th e contract again last night and happen to agree, or am missing it. If I am wrong, it would be usefu l for someone to point me in the right direction. 2. I was also thinkin g about the current reported problem s of the DOD impl eme ntation seeming ly caused by a use r (clini cian) revolt over inadequac y (or un suitabilit y) for th eir needs. The VA run s that same ri sk. Perhap s that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identifi e d by th e users and chart them out. Th en identify which of those issues would be issues if they existed in the VA implementation and include them in th e contract as d efinitional requirement s . You ha ve th e b enefi t of knowing the failures in the very system up on which you are modeling your system .. . and you ha ve an added advantage and opportunity to contractually prevent similar mistakes. 3. I have other thought s as well that we should disc uss, but the se are the ones that I felt mor e pr ess ing to highlight since I will b e una va ilabl e today. Best VA-18-0298-I-000185 Marc Page 233 of 2~1~ of 1380 RE: [EXTERNAL ] Re: VA EHR (12).msg fo r Printed Item: 215 ( Attachmen t 14 of 27) On Wed , Mar 2 1, 20 18 at 8:24 AM , Blackbum , Scott R. wro te: No problem Marc. Thanks for all your help. Very helpful call last night. From: Marc Sh erma n l(b)(6) @gmail.com ] Sent: Wednesday, March 21, 20 18 12:12 AM To: Blackbum, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previo us commitment that I cann ot move. I will catch up with yo u or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote: Bruce/Marc - thanks for introdu cing us to all the expe rts we talked to tonight. It was extremely valuable. We have Stan Huff from Intermountain tomorrow at 10am. I assume you have the calendar invite , bu t just in case it is 1l(b )(6 ) I We have been unable to sched ule anything with Dr. Ko (very bu sy calen dar). We will trying. Scott Scott Blackbum Exec utive in Charge, Office of Inform ation & Tec hnology US Department of Veteran s Affairs VA-18-0298-I-000186 Page 234 of 2~1i of 1380 Document ID: 0.7.1705.535223-000015 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] VA-CIO CALL (13).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000187 Page 235 of 2 18~of 1380 To:RE:[EXT B~~l~°fR8idiij..,_(b___ )(___ 6)_____ From: Sent: Subject: Pg>fnim~1:~ffl} 215 ( Attachment 15 of 27) Blackburn, Scott R. Mon 11/20/2017 10:33:01 PM RE: [EXTERNAL] VA-CIO CA LL Dr. Moskowitz, Thank you so much for the note and for all the help/support. I would love to meet you in person. Do you have any plans to be in Washington anytime soon? l thought the call last week was extremely valuable. The experience and wisdom of the participants is such a great asset - we would be fools to not take full advantage of it. l do agree fully that there was a lot to cover in only two hours. I think the moderator was doing the best he could to get as much out of it as possible, while trying to be respectful of the time that so many important people were volunteering. If the 5 CI0s were willing to follow up, perhaps we schedule another session(s) on various deep dive topics? We would abso lutely love that. Just by way of introduction - I jumped into the CIOrole less than 2 months ago when our previou s CIO(Rob Thomas) abruptly retired to deal with some personal issues. I am a disab led A1myVeteran (MIT ROTC). After getting out of service I went to business school and then to McKinsey where I made partner and spent 9+ years there leading large business transformations in industrial clients . Bob McDonald (the former P&G CEOand former Secretary) convinced me to join VAto lead the turnaround after the 2014 Phoenix scandal. From Feb-Sept, I served as Secretary Shulkin' s Deputy until a political appointee was put in place. Then jumped into the CI0 role to work with the team and make sure this gets done. We are still awaiting a permanent CIO. I would be happy to jump on the phone this week to if you would like. Thanks again for your support! Scott Scott Blackburn Acting CIOand Executive in Charge, Office of Information & Technology US Department of Veterans Affairs From: Bruce Moskowi tz [mai lto:brucemoskowi tzmd@mac .com] Sent: Monday , November 20, 2017 6:02 AM To: Blackburn, Scott R. S ubje c t: [EXTERNAL] VA-CIO CALL D ear Sco tt: I thou ght the V A-CI O call November 15 to help you wit h prac tica l indu stry expe rtise relat ing to your proposed Cerne r imp lementation generated some valuab le conversation. The participant s were some of th e most highly experienced CI Os with deep EMR background s, togeth er with phy sic ian s who focus on medic al error prevention and improving the EMR expe rience. I hope and expect that yo u fo und it of great va lue. Since we have not spo ken before, yo u may not be aware that I am the person who per so nally rec ruit ed the Academic Medical Ce nt ers to provide the VA with advice, int ended to help the VA create and implement a path to fix its care delivery issues, as well as advise on other areas where they can be of value to better veteran s' care. I have been a central point for the group and was the co llection point for the participants ' post-ca ll debri ef. A lso, for referen ce p urp oses, eac h of the peopl e on yesterday's ca Jl has perform ed flawl ess impl ementat ions of sta te of the art EMR syste m s on be half of their respect ive hea lthca re de livery syste ms, some more than once. Since the ca ll was structur ed to focus th e di sc uss ion on the few dire ct questio ns set forth in your age nd a, and the moderator con trolled the timing of each que stion very tightly, the breadth of the di sc uss ionVA-18-0298-I-000188 was somewhat lim ited. As a result , yo u on ly had the benefit of th e experts' advice in the areas that the moderator put on the table ... and the participant' s wa nt to make sure you have the ben efit of their comp lete thought s and feed back . Eve ryone fe lt Kood about Page 236 of 2~1i of 1380 RE· 1EXTERNAL] VA-CIO CALL ( 13).msg for. P1int~d lteQ1: 215 ( Attachm 1rnt 15 pf 27) . . . the cl scuss10n on the agenda questio ns anct reit mat tne scope ana unpt ementation issues relating to DOD / VA interoperability were well in hand. Howe ver, some of the participant s' questions raised about other areas left them une asy about the readine ss of the system for implementation or the readiness of the Cemer RFP contract for execution . Based on some of the offshoot discussions, the participants felt that many non-DOD interoperabi lity solution s have not yet been fully addressed or solved, lead ing to incomplete system plannin g and contracting prot ections, greatly risking an unsuccessful implementation and large additiona l cost and time overruns. The interoperabili ty with commun ity provider partn ers did not seem to be defined comp letely. Some addition al area s that were identified by the VA and its contractor's participant s and moderator as incomplete in the call are: seamless sharing of Choice partner reco rds, duplicate procedure and medical error prevention, flagging mechanisms and implantable device identification, amon g others. Until the design of the system and all function al requirements are identifi ed and comp leted, the participants fear that these as yet undeveloped processes and solution s will re sult in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program. Lastly, at the beginning of yeste rday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process. However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discussion in a two hour phone call with a few questions. Also, as mentioned in the call at various times, the part icipants' did not have access to the RFP contract document , its scope and the contractua l provi sions and protections, a critical part they fee l of eva luating the completen ess of a success ful design and implementation. As such, the participants want to make sure that yeste rday's discussion is understood by everyo ne - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the modera tor, but not as a confirma tion of the project's completeness or readiness for contract execution or implementation, which they believe likely has shortfall s. In general, we liked what we heard, we are honored that you felt our adv ice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implem entation and whether the contract (from the limited discussion) has adequate safeguard s to proceed without risk to the cost and success of the effort. While this was the first time you have spoken to any of these part icipants on the topic of EMR, and maybe on any topic, the participant s wou ld be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomp lete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000189 8~of 1380 Page 237 of 2~ Document ID: 0.7.1705.535223-000017 Owner : Blackburn , Scott R. Filename: RE: Contract Language ( 15).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000190 Page 240 of 2 19~of 1380 To: RE: Contis~rtdB~?'t~MifBS3.fa!f~fifB~S19'i88C~~~R:a~M Attachment 17 of27) Cc: From: Sent: Subject : Windom, John H.[John.Windom@va .gov] Blackburn, Scott R. Mon 4/2/2018 1 :40:53 PM RE: Contract Language Morris, Genevieve (OS/ONC/10) Ll (b.:.... ) (.:....6.:.... ) ____ J~_h_h_ s~.g~o_ v l don 't think I have a phone number for her, but will let you know if I can find it. From: Sandoval, Camilo J. Se nt: Monday, April 02, 2018 9:03 AM To: Blackburn, Scott R. Cc: Windom , John H. Subject: RE: Contract Language Scott,Do you have Genev ieve's work email address and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you , Camilo From: Blackburn, Scott R. Sent: Sunday, April 01, 2018 6:28:05 PM To: Sandoval, Camilo J. Cc: Windom, John H. Subject: RE: Contract Language Yep, I know Genevieve. She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandova l, Camilo J. Sent: Sunday , April 01 , 2018 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Contract Language Exce llent, I' II touch base with Windom tomorrow morning. Also, there's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) jo ining the VA tomorrow on a 120 day detai l. I believe she will be helping us review the contract as well, at least with regards to interoperability, and already working with the EHR team . Do you know (of) her ? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond just reviewing the Cerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Ras u working together to cover the policy and functional aspects of Interoperabilit y? Camilo From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 4:38:47 PM To: Sandoval, Camilo J. Cc: Windom , John H. Subject : RE: Contract Language VA-18-0298-I-000191 Not sure we did. John? Page 241 of 2~ 1~of 1380 •• .RE: Contract LqrliJuaqe .( J 5}.msq for P.1inte.d Item: 21.5 ( Att~hment 17 pl27l . What he might oe ralKmg atrout 1s the feedoack trom the ca 11 s we hao 'l. weeks ago . I believe John and team have crea te d a th oro ugh matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback a nd then und erstoo d how we were reconci ling that feedback). There was also the lang uage that we received via OGC. I'll leave it to John to weig h in. Fro m: Sandoval, Cam ilo J. Sent: Sunday, April 0 1, 2018 7:35 PM To: Blackburn, Scott R. Cc : Windom , John H. Subject: Re: Contrac t Language Scott, I just spoke with Bruce Mo skowit z regarding where things are with EHR and he mentioned you recently rece ived language provid ed by several CIOs (Les lie Coope r, Stan Huff , Stepha nie Reel, Jonathan Manis). Could you kind ly forward me those emails and documents? I believe it was in regards to interoperability. Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000192 Page 242 of 2~ 9~of 1380 To: RE: Fo llo~t ~R~b7Jm,st1:tW rru: 131t'Rhfi l~!~ IW &JJr@~~~g~f{}rn' 20 of27) Cc: From: Sent: Subject : Huweart, Eric D.[Eric.Huweart@va.gov] Blackburn, Scott R. Sat 4/7/2018 3:55:43 PM RE: Follow-up Ccing Eric here. Eric - can you help coordin ate these for next week? To include format/temp lates if necessary (see Camilo' s note below). I would have each give the same briefings they gave me when I came on board a few months ago (just dust them off and update them according ly). Rick and Dom are highest priorit y. I would then say Martha, Lloyd, Alan and Jackie and Luwanda. I also added Helga and Marcy. I'd have them block an hour for each. Sent with Good (www.good.com) Fro m: Sand ova l, Cam ilo J. Sent: Saturday, Ap1il 07, 20 18 11:33:24 AM To: Blackburn, Scott R. Subject: RE: Follow-up Scott, My cale ndar for next week is still empty. Please , I need you to help push harder. For example, I have not heard back from Dom or Rich. You have the list of people I reque sted to meet below and I'm not going to chase anyo ne down . Please have someon e coordin ate this as Bill suggested and let 's get this done ASAP. Also, please remind everyone this is a briefing reque st so i can better understand their area of responsibility and portfolio . Thank you Camilo 917-680-2011 From: Sandova l, Camilo J. Sent: Thursday , April 05 , 2018 9:23:26 PM To: Blackburn, Scott R. Subject: RE: Re: Follow-up Would be sup er he lpful to connec t with your CoS and CFO next. I'm not feeli ng the love, but I might be misrea din g the vibes . Bili sugges ted (per my email last night) tha t the CoS sho uld take the lead in req ues ting 1:1 briefing s. The form at is simple, they can brief me using their preferre d method/format. The main goal for me is to listen and learn and build relation ships. If Eric could help me coordina te with everyo ne 's calendar , th at would be greatly apprecia ted (includ ing Dom). My prefe rence is to have the se briefings comple ted by end of ne xt week if po ssible . Briefing Request Eric Huwear t Rick Chandle r Dominic Cussatt Mar tha Orr Luwanda Jones Lloyd Throw e r VA-18-0298-I-000193 9~of 1380 Page 249 of 2~ Document ID: 0.7.1705.535223-000021 Owner : Blackburn , Scott R. Filename: RE: lnteroperabilty listening sessions (18).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000194 Page 25 1 of 2 19~of 1380 To: RE: lnternERi,lt~~e1i-'?qr _efa~c,1~~~rf.~e~~vW ~go~edItem: 215 ( Attachme nt21 of 27) Cc : From: Sent: Subject : Byrne , Jim (OGC)[Jim.Byrne@va.gov] Black burn , Scott R. Thur 2/ 1/2018 11 :23:21 PM RE : lnteroperabi lty listening sessions Thanks Bob. I did attend today's listening session, 10am-l l:30am. 1did not attend the session at 1pm. For the sake of documenting. Here are a few notes. I sat in the backrow in the Roosevelt Room and was in listen only mode. 1did not say a word during the meeting. The meeting consisted of execs from AARP,Genetic Alliance, National Partnership for Women and Families, Pacific Business Group on Health, PhRMA, Amazon, Business Round table, CVS,23andme, Comcast, Biden Cancer Institute, and Landmark Health There were several government rep rese ntatives (from White House, CMS, ONC). Jane Lucas was present in the meeting. The meeting was a classic "listenin g sess ion" st ructured around the following 3 questions: o How import ant is interoperability to you and why? o What have been the main barriers to interoperability an how can we overcome them together? Are there any regulatory burdens we should examine to expedite efforts? o What approach(s) do you recommend to provide maximum benefit to the patient? What other factors should we be cons idering? Fro m : Fleck, Robert R. (OGC) Se nt : Wednesday, January 31, 2018 8:28 AM To : Blackburn, Scott R. Subj ec t: RE: lnteroperabilty listening sessions Scott, (b)(5) Bob Robert R. Fleck Chief Counsel , Procur ement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington , DC, 20420 Office 202-461-4954 ATTENTION : This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege . Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this informa tion without prior authorization from the sender. If this has inadvertently reached the wrong party, please delete this information immed iately and notify the sender. Any secur ity screen ing of this email by information officers or server adm inistrators is not intended to be consent to any party to review the content of the emai l or a waiver of the attorney-client privi lege and/or work product privilege. Fr om : Blackbum, Scott R. Se n t: Tuesday, January 30, 20 18 2:53 PM To: Fleck, Robert R. (OGC) Cc :!(b)(5) I VA-18-0298-I-000195 S ubj ec t: RE: Int eropera bilty liste ning sessions Page 252 of 2~1~ of 1380 RE: lntero~e rabilly,Jii,tenirJp sessions (18).msg for Printed Item: 215 ( Attachment 21 of 27) Can we ta IK at J.Jupm. From: Fleck, Robert R. (OGC) Sent: Tue sday, Janu ary 30 , 20 18 2 :33 PM To: Blackburn , Scott R. Cc: Byrne , Jim (OGC) Subject: RE: In terop erabilty lis tening sess ions I can see you now. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 81 O Vermont Avenue, NW Washington, DC, 20420 Office 202-46 1-4954 ATTENTION: This electronic transm ission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party , please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege . From: Blackburn , Scott R. Sent: Tue sda y, Janua ry 30 , 20 18 2: 32 PM To: Fleck , Robe rt R. (OGC) Cc: Byrne , Jim (OGC) Subject: RE: Int eropera bilt y listening sessions (b)(5) From: Fleck, Robert R. (OGC) Sent: Tue sday , Ja nu ary 30 , 20 18 10:27 AM To: Blackburn, Sco tt R. Cc: Byrne , Jim (OGC) Subject: RE: lnt eropera bilty listenin g sessions Scott, (b)(5) If you have any questions, please let me know. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel VA-18-0298-I-000196 Page 253 of 2~1i of 1380 RSbr'At e{~ 5'Qbilty listening sessions (18).msg for Printed Item: 215 ( Attachment 21 of 27) 81 O Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privi lege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party, please de lete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the emai l or a waiver of the attorney-client privi lege and/or work product privilege. From: Blackburn , Sco tt R. Sent: Monday, Janu ary 29, 2018 11:04 AM To: l(b)(6) I Cc: Fleck , Robert R. (OGC); Byrne , Jim (OGC); l-(b_)(_6_) -----~ Subject: Interoperab ilty liste nin g sessions Ja ne, It was a plea sure meetin g you toda y. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob - Chris Liddell asked me (or someone from VA- perhaps Windom or Ash) to attend a few interop era bility listening sessions at the White House (there is one or two of them this Thursday). Jane wanted to loop in with you guys to make sure that makes se nse given where we are with the Cerner contract. It would be just listening mode (from the secon d row). Scott Scott Blackburn Acting CJO& Executive-in -Charge, Office of Information & Technolog y Depart ment of Ve te ran s Affairs VA-18-0298-I-000197 Page 254 of 2~1~ of 1380 Document ID: 0.7.1705.535223-000022 Owner : Blackburn , Scott R. Filename: RE: SecVA (19).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000198 Page 255 of 2 19~of 1380 To: RE:SecV~1~<mfh~~~'b1\ef¾:{grc'dlr~~d~JrW~!r.,1(b)(6) ta>va.r;v) Cc: Colli, Jacquel ine[Jacqueline .Colli@va.gov] ;jb )(6) va.gov]; Rinchack, Diane[Diane .Rinchack@va.gov]; Llamas, Jose[jose .llamas@va .gov]; Turner, Tanya T.[Tanya.Turner3@va.gov] I From: l(b) (6) Sent: Fri 3/9/2018 9:10:18 PM Subject: RE: SecVA Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to trave l, Scott. Sorry about that . Thank you. From: Blackburn , Scott R. Se · , 2018 4:09 PM To: (b)( 6) Cc: Colli, Jacqueline (b)(6) Subject: RE: SecVA~-----------~ Rinchack, Diane; Llamas, Jose; Turn er , Tanya T. Awesome! Thanks so much. From: l~ (b_)(_6)____ ~ Sent: Friday, March 09, 2018 2:50 PM To: Blackbum, Scott ,_R_.___________ Cc: Colli, JacquelineJ(b)( 6) Subject: RE: SecVA __, Rinchack, Diane; Llama s , Jo se; Turner, Tanya T. I Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackbum, Scott R. Sent: Frida March 09, 2018 2:19 PM To: (b)(6) Cc: Colli, Jacqueline; (b)(6) Subject: RE: SecVA ~-------------' I'll be there. I'll plan to mimic hi s sche dul e. Sent with Good (w ww.good .com) From: l~ (b_)(_G_) ____ ~ Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline; l,(b-)(_6_ ) -------------, Subject: SecVA Scott - just a heads up that boss wants you to travel with him to Mar-A-Largoon 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-I-000199 Page 256 of 2~1i of 1380 Document ID: 0.7.1705.535223-000024 Owner : Blackburn , Scott R. Filename: RE: VACIO advisory support for Gerner contract (21).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000200 Page 259 of 2~ 0~of 1380 To: RE: VA C/:?e\lR~Wi~~';t(lif Pa'HPn ~r~l:9~b~1lb~r@f>~?gdo/] From: Sent: Subject: Printed Item: 215 ( Attachment 24 of 27) Blackburn, Scott R. Fri 11/3/2017 10:23:29 PM RE: VACIO advisory support for Gerner contract Thanks Avi. I managed to find the other 4 . I will shoot them all an email over the weekend. I'll cc you guys too in case you want to be included . Thank s for all the sup port. Have a great weekend, Scott From: Berkowitz, Avrahm J. EOP/WHOl(b)(6) ~who.eop.gov] Sent: Wedne sday, November 01, 2017 9: 33 AM To: Blackburn, Scott R. Subject: [EXTERNA L] RE: VACIO advisory support for Cerner contract (b_)(_6_) ____ Richard D. Daniel ~.__ ..,..k@_k~p_. o_r~g Here is th e first he can help likely with the others - let me know if you need help tracking them down - I don ' t have them at the moment From: Blackb urn , Scott R.fmailto:S cott.B lackb urn@ va .gov] Sent: Tuesday, October 31, 2017 4:31 PM To: Berkowitz , Avrahm J. EOP/WHO~who.eop.gov> Subject: FW: VACIO advisory support for Cemer contract HiAvi, Happy Halloween! I just want to follow up on thi s exchange wit h Jared. Can you help connect us with the 5 CIOs so we can bounce our EHR plan off of them before we go final? Thanks again for all the support! Scott From: Kushner , Jared C. EOPIWHOl(b)(6) @who.eop.gov] Sent: Friday, October 27, 2017 5:36 AM To: Blackburn, Scott R. Cc: Liddell, Christopher P. EOP/WHO; Windom, John H.; DJS; Berkowitz, Avrahm J. EOP/WHO; Dumbauld, Cassidy M. EOP/WHO Subject: [EXTERNAL]Re: VA CIO advisory support for Cerner contract (b)(5) Avi will co nn ec t you and sched ule next meeting Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R. wrote: Jared / Chris (b)(5) VA-18-0298-I-000201 t-'age .:::ovof 2~b~ of 1380 RE: VAC IO advisory support for Cer1wr contract (21) .JTISQ<~ tracted> for. Printed ltwuf· 215 ( Attachmetit 24 of 27) co urse we wou10 Jove tor the two or you to Jom as well I you are availab le. (b)(5) Scott This is Scott Blackbw-n, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours. I will be accompanied by the Program Executive Officer for VAElectronic Health Record Modernization (PEO EHRM),John Windom, and his key staff members including his Chief Medical Officer (CMO), ChiefTechno logy Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterpa rts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFP with particular emphasis on notable "fail points" EHRdeployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc. to name only a few, but look forward to your thoughts on these and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000202 Page 261 of 2~b~ of 1380 Document ID: 0.7.1705.535223-000025 Owner : Blackburn , Scott R. Filename: RE: VA MEETING (22).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000203 Page 262 of 2~ 0~of 1380 To:RE:VA From: Sent: Subject: ~JS~~Jg1f~~• _r §f>~f> for Printed Item: 215 ( Attachment 25 of 27) Blackburn, Scott R. Tue 11/ 14/20177:15:28PM RE: VA MEETING thanks From: DJS Sent: Tue sday, November 14, 20 17 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For th e 5 CIOs who ask, I will tell them th at Bruce is an advisor and exte nsion of the WH/VA team. Is th a t ok to say? From: DJS Sent: Tue sday , November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VAMEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with th e 5 CIOs is Wednesday 3-Spm. On our p re -calls, 2 of th e CIOs have asked about Bruce and wha t his involvement is. I have neve r had any contac t with Bruce, but it seems like a sensi tive relationship. Any advice on ho w to han dle? We invited Jared/Chris from WH as a court esy. I don't think either plan to join, but th ey must have invited Bruce who is now asking a few others to join (see below). Can discuss live lat e r before or after hearin g prep. Scott From: Schnitzer , Jay Jl(b) (6 ) ~ mitre.org) Sent: Tuesda y, November 14, 20 17 12:47 PM To: Blackburn, Scott R. Cc: Wynn , Jacki e VA-18-0298-I-000204 Page 263 of 2~bi of 1380 Hi Scott, Pl ease see the ema il trail below. Ju st wan t you aware in case we have people j oining the call wi thout your know ledge or approval. Thanks, Best , Jay Jay J. Sc hnit ze r, M .D. , Ph.D. MITRE Fro m : Noga, James l(b)(6) @PARTNERS.ORO> Date: Tuesday, Nov 14, 20 17, 11:43 AM To : Karson, Andrew Scott,M.D.!< b\/6\ @mgh.harvard.edu> Cc: Schnitzer, Jay J !lb\/6\ @mitre.or g> Subject: RE: VA MEETING But d o th e people h osting th e call know you are going to be on the call? I am copying Jay as he is helping coordi nat e th e call. Jim From: Karson, Andrew Scott ,M.D. Sent: Tuesday, November 14, 2017 11:3 1 AM To: Noga , James !(b)(6) @PARTNERS.ORO> Subject: RE:VAMEETING Dear Jim, Tha nks for the not e. I think that you a nd I ma y have a little mis-under stan ding. I agree th at you can of course hand le th e call, but Gregg and Bruce Mo skovitz in vited me to th e call tomorrow so th at they can have a hand s-on clinicians perspective. Bruce and I spoke very briefly (b e tween h is pa tien ts) a little while ago and Bruce sen t me the below informa tion. I am h oping to touch base with you before th e call if th a t is possible for yo u. I am tied up in pre se ntation s/ meetings the rest of th e da y, but co uld speak th is eve n ing (6pm?) or tomorrow if th a t is okay with you. (And if needed I will break o ut of o the r meetin gs today) . Many than ks, Andy From: Noga, James Sent: Tuesday, November 14, 20 17 11: 16 AM To: Karson, Andrew Scott ,M.D~(b)(6) ~mgh.h arva rd.edu> Subject: RE: VAMEETING I h ad a call with them toda y in prep for tomorrow 's call. I appr eciate the offer but I don 't th ink it is my p lace to invite yo u. It needs to come from th e VA. From: Karson, Andrew Scott,M .D. Sent: Tuesday, Novem ber 14, 20 17 11: 11 AM To: Noga , James l(b)(6) l@PARTNERS.ORG> Subject: FW: VAMEETING Dear Jim, Given some conflicts th at Gregg has being a se nior adviso r for th e VA, Gregg has asked me to join th e 3pm VA call tomorrow to be availab le for the clinician pe rsp ective. Wou ld you be up for a 15 minute check -in call with me at some poi nt tomorrow before th e VAcall? If so, then I'll reach o ut to Susan Briggs to get us a time. Ma ny th anks , Andy From : Karson, Andrew Scott ,M.D. Se nt: Tuesday , November 14, 20 17 11:06 AM To: 'Bru ce Mo skowit zr )(6) ~m ac.com> Subject: RE:VAMEELNG VA-18-0298-I-000205 Page 264 of 2~b~ of 1380 RE: VA MEETING (22).msg for Printed Item: 215 ( Attachment 25 of 27) Dear Bruce, Many than ks for the note. I'll review the below a little later today and I'll be back in touc h. Many thank s and best , Andy From: Bruce Moskowitz l(b)(6) @mac.com] Sent: Tuesday, November 14, 2017 10:45 AM To: Karson, Andrew Scott,M.D. l(b)(6) ~mgh.harvard.edu> Subject: VA MEETING The call will take place this Wednesday, November 15th between 3:00 PM and 5:00 PM Dial In Number : ..... l(b_ )(_6)___ ___, Passcode:~l (b_)(6 _) -~ Thank you for your time and involvement. Some background information. These are my concerns as a clinician. Cerner does not have the ability to provide the following in the Choice Program: Track ing duplicate testing Tracking over utilization by providers Tracki ng duplicate prescriptions and medication errors. Tracking tests that were ordered , completed and results go to all physician s involved in the Veterans care Patient notification of critically abnorma l results with follow up resolution Arranging appointment followup between the VA and Private sector Emergency room visits in the private sector ability to access records immediately and VA physicians notified of emergency care and followup Cemer has no registry to tract what Cardiac and orthopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Provider to the VA patient record with flagging new information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radio logist needs to know if a lung nodule is new or was there previously and the same size. Cardiolo gists need to access catheter ization films in high definition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in real time. Sent from my iPad Bruce Moskowitz M.D. The information in this e-ma il is intended only for the person to whom it is VA-18-0298-I-000206 Page 265 of 2~bi of 1380 RE: VA MEE.TING (22)..msg lo~rr inted Item: 215 ( Attachment 25 of 27)th . addressed. lt you be11eve tms e-ma 1 was sent to you m error and e e-ma 11 contains patient information, please contact the Partners Comp liance HelpLine at http://www.partners.org /compliance line . If the e-ma il was sent to you in en-or but does not contain patient inform ation, plea se contact the sender and properly dispose of the e-mail. VA-18-0298-I-000207 0~of 1380 Page 266 of 2~ Document ID: 0.7.1705.535223-000026 Owner : Blackburn , Scott R. Filename: RFP review matrix draft_v8.xlsx Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000208 Page 267 of 2~ 0~of 1380 RFP review matrix draft_ vB.xlsx for Printed Ite m: 215 ( Attachment 26 of 27) tem # f\ut hor ·omment Response Modi ficat ions to KJ'P Ml n th is co ntract (and I may have missed it), I 'Ould fi nd no clear defin itio n of expectatio n.~ _DlQ PWS Secti on 5.10.4: Seamles s Int eroperab ility / Joint lndust r)' Out reac h includes significant deta il o n th e to pic. The int ero perabili ty sect ion is cop ied below th is t able for re feren ce. INo cha11ge required. egarding Cerner's ability to "interopera te" IDIQ PWS section S.5 .4 Data Hxcbangc - AppUcatiou Program Interface (APJ) Gatewa y also includes detail o n the creat ion of st rategic ope n APls. on Manis vi rh o ther EMR ve ndors (Epic. Med it ech, ' clipsys. Allscripts. etc.). Though there is ·efere nce to interoperabiUty . my suspicion is hat it is de fined a.s ··lh e passing of ce rtain ~linical data e lemen ts" o r ··the exchange of j::erta in re leva nt clinica l data e le me n ts" be tween d ispara te EMR vendors . This may be ktefmed as dat a excha nge 01· in terface. b ut it is 10 1 the tru e , sea .mies..'\inter o pera bility or ntegration drnt wa s sugges ted in l::onversat ions I have pa rt icipated in with VA stakeholders. M2 on Ma nis VA NF-177: Int eroperabilit y - Data Standards: The syscemshall support the use of the health data standards identified in the VA DoD Health lnformarion TechnicalSt andards Profile and by he VA DoD lnteragency Cli nical Informat ics board. including following common data standards: National Information Exchange Model NIEM: Health Level 7 HL7: Logical Observation dcnt ificrS, Name s a nd Codes LOINC; Systematized Nomen clat ure o f Med icine SNOMED: RxNonn , MedRT, ICD. CPT, HCPCS, Vete ran ln forma tion Model VIM; and Healthcare In form a tion echnology St andardsPanel HITSPas well asVA/00D/JPO extensions to t hese standards. ,'A•NF-123: Infor ma t ics - Care Inte gration: VA muse be ab le to seam less ly int egra t e with HIE and exter nal-co-EHRshared services to prov ide for a seam less experience a nd to more effeclively integra te in community care efforts. as we ll as with other parts of VA(e.g .. ident ity managemen t). This include s bu t is not limited to t he EHR product abilit y to support external ·h ared sen •icc.'\(SOAse rvices, such ~1s ide nt ity mana ge me nt . ca.r e plan se rvice. sched uling. et c.) acccs:sed \1ia standards •ba.~edAPls. (Proccs:s Continu ily, Evo luti on, Extension ) KSR5 INOW +l VANF-Zl L Health lnfom1ation Exchange: The system shall suppo 1t VAelectro nic excha nge of health reco rds via ot her interoperab le netwo rks (e.g. CareQ uality, Common Well Health Allian ce. DirectTrus t . Natio nal Associat ion for Trus te d Exch ange) by suppor ting t he ir specifica tions. sec urity a nd conten t spec ifications I bring thi s issue to the fore 011 ly becausemy Seeresponse to JM I . ·o nvcrs.a tions have led me to bel ieve th a t lh e Also.the RFP represents a contracrual agreement with Cerner. Cerner has agreed to open APls. VA data rights. and adherence to data standards to supporr interoperability. Outside of the 'tru e interopera bilit)"' with this Cemer e rn er co ntract, VA is act ively pu rsuing part ners hjps wit h ot he r heal th sys t.em prov iders to mee l Cem e r's co 1111n itme nl to da ta sha ring. ·o ntrac t. Any such intere st would requ ire ontrac tu al lerm s and a clause develo ped, :tgrecd t o, a nd exec uted by Ccrncr as we ll as he orher primary EMR vendors (Epic. Eclipsys. Medit ech. Allscripts. and ot hers). Faili ng such l con tra ctua l obl igat io n. the Ccrncr con trac t ·epresents an exceptiona l c urren t-sta te ~ortware a greeme nl. but no sign ifica nt progress or advancement toward true EMR nl.eropera bility. 'i/\ 'o clumge required . ~A was pursuing a contractual obligati on for VA-18-0298-I-000209 0~of 1380 Page 268 of 2~ RFP review matrix draft_ vB.xlsx for Printed Ite m: 215 ( Attachment 26 of 27) JM3 Jon Ma nis cou ld not find spec ific re fere nce to existing ~ata and the migracion of existing da ta from he curre nt. VistA da1abases 10 1he Cemer ~a t abasc. Is this multiple da ta migrat ions'! t::'rom how many existing databases to how _DlQ PWS section 5.1.8: Data Migration Plannin g: - details o n data migrat ion plann ing inc luding: The Contrac tor shall support da t a migrati on planning to su pport sea mless care and to ensure operat ional integrity . The Contractor shaU: a) Develop a Data Migra tion Plan (DMP) that prm•idc.~ an unders tandi ng of t he EHRMSolution imp lementat ion sequen ce and prior ities, data qual ity, data volumes , and data cxtn.1c:1, No change required. ransformation and load strategy for both the EHRMand Popu lation Health Management solutions. rnm y instances o f the Cerner database ? IDJQJ'WS 5.9: 5.9 AnalysisAnd Migration orLegacyData he Contractor shall execute the followin g data mig,rat:ions in alignment wi th the EHRM wave dep loyment schedu le. Data migrations incl ude: a) VA cli nical data migrated t o Hcalthcln tcnt - ini tial ly 15 d omai ns b) Non-DICOM Images c) DICOM images . Referen ce 'i. Diagnostic qua li ty Additional migra ti ons shall occur followl11g the overa ll EHRM schedule: a) Bulk VA data from Healthe lnte nl t o M illenni um -i nitia ll y 5 doma ins . lnitia l.ly PAMPI: Problems. Allergies. Medic atio ns. Procedures. Immu nizatio n i . Mov ing to PAMPI+ ii . DICOM imaging and imaged doc uments and other mull ipmed ia will not be included In the init ial pha.~esor migrat ion . b) It erative migratio n of remainin g VistA clinica l. dental. admi nistra tive and fina ncial data tha t is relevant for cl inical care, registries. report i ng. or analytic s to addit ional doma ins in Healt he lnt e nt and/o r Mille nnium Priorit ies w i.1 1be dete 1m ined by the Dat a Governa nce Board . ) M igratio n or archiving of rema ining VisrA data per direction or the Data Governa nce Board to enab le retirement of VislA instances. he Contracto r shall deve lop the data processi ng scripL" incl ud ing term inology mapp ing to standards. and inform ation model tran sformat io n. he Contractor shall migrate VcstAlegacy data into Heal theln tent utilizing a historica l bul k load and an ongoing update stream d uring t he dep loy ment time per i od based upon the following process: a) VA w ill physically t ransport the historical load 10 the Cerner Data Center and restore onto an enviro nmenl est ablished for hosting VA data: b) VA will manage the ongoing update stream; ) The Contractor wi ll ingest. aggregate. nonna lize and standard ize the VA data into Healthe lntent and/or Mill enn ium by a predeterm i ned method. M4 on ~an is IVistA and (ancHlat)' system s displacement s) ~hould ha\'C a data migrat ion schedule with ~ata i ntegr ity assurances. M5 on Man is I could not find speciftc rererence to EMPIand dent ity management. I wou ld be co ncerne d :tbout d upli cate recor ds, record re solution . lfhe expectation should be defi ned w it h a ime li ne and accepLable error rate . \Vhat is he process and accountab il ity for dupli cate ·esolut io n? IDIQ PWS Secti on 5.5.2: Id entit y and Access Management i ncludes significant detail. -.'A NFPI 5: The syste m shall be able to synchronize all pati ent ident ities to the enterpr ise ldenl ity J\•fanagement System (i .e ., DfERS, MVO he details of data migra ti on schedu ling for VA enterpri se data, VA (OCdeplo ymen t data and imaging will be incl uded in the data migration task order and Cemer propo sal in response to hat task orde r. ~,locluwg e required. ~ No change requ ired. >'A - Nl' 24: When com munication s allow, t he system shall enforce a search t.o t he enterprise Identit y Mana gement System (i.e ., DEERS,MVI) prio r to adding a new pati ent VA-NF52: The system shall support t he match ing of E.xtem al Pati ent IDs com ing in th rougl 1 eHealt h E;tchange/Common \ Vell and other com mun i ty partner syslems. M6 on Man i s s there a speci fic li sting of ancillary systems hat will be displaced by the Cerner EMR? If ~o. I did not see that li sting. 'cs. VA has:compiled a mapp ing of Ccrne r to VistA modules to identi fy w hat VisLAco mponenL~ w ill or will no t be replaced b y Ccrn er module s. That list is used i nternal ly by VA to determ ine INo cha11ge requ ired 1ex.tstep s for rema ini ng VistA componen ts. As the se componen ts will not be rep laced or managed by Cemer. they are no listed as part of the Cerne r RA>. The Cemer solu1ion rep laces all linica l modu les of Vist A and do es away fo r th e need of many non •clinical modul es. M7 on Nanis Is there a specific listing of ancillary systems hat will be retai ned post Cerner EMR mpleme ntatio n? 'cs. VA is maintai ning a list or ancillary systems that will be retained . As these systems will not be managed by Ccrn cr. they arc not li sted as p art of th e Cemcr RFP. INo cha11ge required. VA-18-0298-I-000210 Page 269 of 2~m of 1380 RFP review matrix draft_ vB.xlsx for Printed Ite m: 215 ( Attachment 26 of 27) MS did not see a s1>ecific re fere nce to sys te m on ~an is l 7 A NF•86: User Operational A,•ai lability • Syst e m ava i.lab ility excl usive o f plan ned dow ntim e shall be 99 .9% for t he Tier I product ion syste ms a s de fined in th e Hosting Scope doc um ent . INo cha11ge required. ()erfonn ance commitme nts. Such a reference Syst em avail abil ity exclusive of plann ed downt ime shall be 99.9% for the HA·CAS producc ion syscems as defined in the Hosting Scope document. Healthel nten t compon ents req uired for d ata ~hould include defined response times (user nigrat io n and co nt inuity of care shall have th e sa me SLAand pena llies as Tier I produ ction syslems as defi n ed in the Host ing Scope doc ument . ~cfincd performance. no t mac hine dc lincd pe rform ance). uptime commjtmen ts and ·eso lut io n accou ntab ilit ies. These shou ld be ~efineortthe int.cgra tio n with EHRM. 1naddition , the Contra ct.or sha ll J>rovidc tcclmic a l cxpcrt. isc to VA and its Contractors to su 1>port integra tion wit h EHRM of Commercial ·of'tware as required. Not e tha t s ite•s p ecific syst em interface and legacy syste m modifi rntion may be re qu ired as site requirements are identified during deplo }'m e nt. VA will prO\•ide access to VA's ent erprise ln t erSystems Healt hShare licenses for development o f EIIRM/VlstA interfac es. The Cont ractor sha ll pr ovide int erface tes tin g. Tests includ e steps for nominal and off-no minal interface condition s, minimum a nd ma ximum dat a con te nt , and error ha ndlin g as outlined n the respecth ·e !CO. Oata will b e verified on each end o f the Interface to confirm that the correct data Is transm itted from EHRM and th e data re0rting and analyt ic roo ls to reporl a nd a nalyze the data VA-18-0298-I-000211 Page 270 of 2~1~ of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) Ml2 on ~an is M 13 on ~an is Some co nt inge ncy should be mad e for rnrdware perrorm ance measureme nt proce ssing and resix>nse times) wit h regar d to :tssigncd accounta bility. If the system is ~nderpe rforming. who is accountable to ·emed iate? How q uickly'.? erner is pro\~d ing a ma n aged hosti ng se n •ice an d the ir Ligh t sOn Mon.itoring to VA. INo cha11ge required. 1~0T E: There is a separa te Cemer Hostin g Scope of Work doc ument th at is not a pa.rt o f the RFP bu t wHlbe incorporated in the final con tract language. Specific hardware perfor mance and cmcdiat ion p rocedure.,; arc described in lhat doc ument includ ing t he provisio n o f ncar •rcal Lime views int o syst em capac ity, pe rfor mance. and use r dev ice latenc y o n both a snaps ho t and rend view, System availabili ty.performance and funct ional capability issues are handled as an incident with re.solut ion time frames specifi ed by t he criticalit y of each i ncident. Detailed metrics will be include d in task orders describi ng host ing and help desk req uirement s. I d id not see and co uld no t find spec ific VAand DoD will be sha ring an instan ce of t he co mmercial Cerner produc t based in the Cerner data ce nter co nfo rming to Cerner co mmerc ial se rvice level agreement s. Note that spec ific .-nention of service leve l agrcemcnL °' rega rd ing ·ervicc le vel agrcem cnL°' will be de term ined for eac h task orde r. ·espo nse times . _DIQ PWS sec tion 5.3.3 Syst em Qualit y and Performance Meas ure s and Mon itoring ~1o chan ge required. he Contractor shall provide its co mmerc ial performance mea sure ment system for syst em acce ptance for discussion and re, riew with VA. The Contrac tor shall cond uct ana lysis and de sign :i.ctivilie.°' for syst e m qu ality a nd performan ce. 1l1e Contra cto r shall prov ide pe r formance a nd a vailability tre nd an alysis a nd supp ortin g dat a in the Monthl y Progress Repo rt to ,°'how pred iction. trend ing. an d mon it oring of system 's performance trends . The Contrac tor is res pons ible for re porting all issues or errors associated with the EHR so lution. and acknow ledges and agrees thal software e 1Tors creat ing pat ient safety risks sha ll no t be cons ide red con fid ential. propr ietary or trade sec rets. and acco rdingly, sha ll be re lea sable to VAor its age nts. The VA etains the right to share any issue. error or reso lution approac h re lated to so ftware errors crea ting patfont safet y risks. Qu,,lity Assurance Sun ·eilhmce. Phm Append ix A-1: EHRM Funrtion, 11Key Performam. ·e Indicators inc lude.°' over 120 area.s o f clinic al meas uremen t a.long with speci fic det ail o n VApr ior itie s and Cerner Light s On measurement capabili ties. These metric s w ill be included as app ro pri ate in each ta sk ord er wit h VAsurveill ance on Cerner perfonnance against t hese metr ics, Quali1)' Assurance Sur\'eillance Plan Appendix A-2: £HRM Non- luoc1iona l Key Perf orman ce Indicators includes 20 areas of technical measuremen t along with cri1ical success facto rs and ~ugges ted numer ical measures . 1l1ese metrics will be included as app ropriate in eac h task o rder with VAsun •e illance on Cerner performance against t11ese me trics. Ml 4 on Manis did not see and cou ld not find specific IDJQ l'WS serocesslngtool s and runctionalil:i es: Discussionswith CMO imagi,lg:representatives clarified that image pos1 processi,lg is ri ot within scope o f lhe Cenl er cont ract si,lce VA is I} The objective would then be a "captu re once. s 1ore once. access nOl pun:ha s ing the Cemer PACSmodu le . nftnite times · with defined SLAsand perfonnance metrics L) Also, 1,1 ease make sure that thel'e is mention of a fu1l c1io1,al "zerooot prin t viewing" (ZFP)capa bilities. DI also did not see direc t menti on of image pos t processing too ls and unctionalities (e.g. 3D imaging. compu1er added detec 1ion/CAD, etc .) VA-18-0298-I-000216 Page 275 of 2~m of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) RS3 Rasu Shre sth a It will be important to make sure that th ere is robust dat a integrat ion DIQ PWS section 5.1.8 • details on dala migrat ion plann ing including : The Con tractor s hall su pport duta migra tion planning to sup port seamless care and to ens ure operationa l integrity . md pe rformance ac ross all site.11 'he Contractor shall: ·1,ilo clia11gereq11ired. :1) Develop a DarnMigration Plan(DMP) thm providesan unpat ient entere d darn D data from re mote de, •ices and sensors L) claims data/ payor dat:a D dat a flow from existing solut ions such as \listA D dat a flow ac.ros..11 other EMRs including Epic. Alls.cripts e tc. - to mee t ·md e:.;c eed nee ds around the Veteran s Access. Cho ice and A.ccountab ility act DIQ PWS Section S. I 0 .4 : Seam less Interoperability/ RS8 Rasu Shre sth a I wou ld also llke IO dig deeper with you around ad\·tu1ced ana lytics. enterprise da ta warehousing. and ena blemen t of artific ial inte lligence rnd machine le an1ing type cap abilities IDIQ PWS Secti on S.10.2: lnnm ·ation Categ ories includes significant deu,il co ,•ering futu re -facing development. Specifically: Joint Industry Ou trench include -s significant deta il 011th e top ic. TI,e i1Heroperabi li1y sec tion is copie d be low th is tab le for reference . 1'fo clumgt: r eq11ired. 1\fo change req11ired cl) An exteos io11o f the EMRM using eithe r Cont ractor -dependent or indepe11dent techno logy. An example of an e:ctension includes a new app licat ion such as a growt h chart app licinion or med icatio n adh erenc e applicat ion. An inde pen dent app lication may use Fast Healthcare Interoperab ility Resources (FHJR) a nd a SMARTcontainer t o visualize the a pplicntion in the EHRJ..·1. 1\11 exam ple of a Co,,tract or-de pend e11t i;rnova tio,, is a similar app lication that leverages Cont racto r prop rie ta ry objects -or ie ,ned t ed rnolog_ies and APis to co ,,11ect the applicatioo to th e EH. RM. The Task Order will describe the specific requ irement s o f Contra cwr LOsustain the extension. An extension will typically be owned by Contrnc wr and licensed 10 the VA with unlimite d rights and subse quen tly ma de ava ilable unde r an open so urce license such as APACHE.Version 2. e) An oper l innov a1ion is a foundationa l, platform indepe,1den t techno logy t.ha1 may be utili1.ed wi1h Con tractor solut ions bu 1ha s independen t value outsi de ofCon tract or·s plat forms . E~amples include Cemer lerm inologies, onw logies, melhod s of developing healthcare rr conten t. s tan da rds processes and rules. for examp le. such as lhose employed to program Cerne r's popu lation health so lutfons . Open innovation Intellectua l Proper ty (IP) will be committed to an open source communi ty or public domain . as ap propr iate and mut ually agreed to in a Task Order , by Corura ctor and the VA whe rl such open inno,•atiOrl LP is 11ecessa.r)r to re alize a sta ndard ized imp lementation of platfo t m-i.ndepeode nt hea lthcare IT content. f) A jo int con tributi on is a n innovat ion created and developed by Contra ctor an d the VA. If the \IA is not co ntribut ing funds. then a CRADAma)' be negot iated to facilitate the Joint ontr ibution in cool'dination with the VATechnology Transfe r Program (TIP) . The VA ma y rec.eive considera ti on in the form of sof tware allowan ce.,;;.fut ure lic.ens ing discounts, or othel' emunera 1ion , accord ing lO parameters and amounts pre.,.iously agreed by the lnno vations Governtmce Board as doc umented in a wrillen ;1grecment subseq uent ly incorp0rated inlO this onu ·act or one of iLiiTask orders. and joint inventors of patent ed inventio ns mar rec.eive royal tie.11 in the se armngemenL~ in acc.ordan ce with pate nt license agreement s to be es tab lished hat are co nsistent wi1h Contract Clause LXXX,Patent Rights -Owne rsh ip b)' the Con trac tor , FAR52 .227 -12. (DEC2007). If the VAis a lso co, Hributin g funds, the r\ a n alt.erna tivecooperat.i ve de"elopment agreement may be requir e d for Join t Contribut ions. Joint Innovations nn,de in concert with the DoD mt,y be dc\·e loped under tm Other Transaction Aut hority (OTA)i,greemen t. g) A know ledge shar ing inno\'ation is a conu'ib ution to a standar ds mganization or con so nium to advance the knowledge set of the indu sUJ at large. Exampl e.~include contr ibutions made to he ONC as part of the. Direc t Projec t or the Common We ll He.alth AJljance . VA-18-0298-I-000218 Page 277 of 2~m of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) rt,9 Rasu Shrestha Does the co1nrac1 specify that this is a single i1lstance sharedby VA and ¥bile th e words 'single instance' do no t appear in the contract. there are mu ltiple referen~es to 'single jo int syst em'. 'common system'. etc. throughou t th e RFP as illustrat ed below . ·1,ilo clia11gereq11ired. DoD? DIQ PWSB;u:kgrou.nd Section: EHRMis basedon the electronic healthrecordact1u ired by the Department of Defenseknownas 1he MHSGENESIS system,which is ru itscore, Cerner ii a common system to htl\'C a seamless link between the DoO and VA. The DoD i\1illennium. The ado ption of a single jo int system between VA and DoD will allow all patien t data to reside a,, :authorized system will be augme111edto include additional funclionality 10 meet VA requirements. Over time, 1he goal is the creat ion of integrated inpatient and outpa1ien1 solu1ion wi1h · oftware comp0nentsthat ha\·e been designed,integrated. maintained.and deployed with a design archilocture thm aLiowsfor accessto and sharing of common darn. common user ntcrface.common workflows.commonbusinessrules. and common security frameworkthat supportscnd•to•end healthcarerelated clinical and businessoperations. 5.10.4 Seamless Interoperability I Joint Industry Outreach The Cont ractor is required to co llabora te with VA affiliates, comm unity partners, EHR prov iders . healt hca re providers. and vendors to advance seamless care throughout the health care provider market. Seamless care will require lhe creation of an integrated inpatientand outpatient solutionwith softwarecomponenlsthat have been designed, integrated, maintained. and deployed wit h a design archttecture that allows for access to and sharing of common data and an enabl ing security framework that supports end -to- end healthcare relatedclinical and business operations. Seamless care is the experiencepatients and providers have moving from task to task and encounterto encounter within or betweenorganizations such that high-quality decisions fem, easily and complete care plansexecute smoothly, Information systems supportthe seamless-care experience by gatheringdata, interpreting data, presentinginformation, and managing tasks. Currently, industry lacks specific and uniform interoperability standardsto support seamless ca re between organiza tions that employ di fferent EHR systems. The Requirements Traceability Matrix Section D, Attachmen t 003. sets forth specif ic Informatics and Interoperability contract requirements. To accomplish this, the Contractorshall providesoftwareand servicesto enable seamless care betweenVA encounters, encoun te rs with other Government healthcare institutio ns, and outside entities through advancements in all areas of the EHR that occur. In addition, the software and services shall support the VA designated standards, such as SMART on FHIR and SMA RT-enab led applications . o r other published standards . The obj ective of these int eroperability solut ions is to advance the state of the art supporting seamless care for Veterans . Existing organizat ions promoting interope rability among EHR vendors. such as The Argonaut Project, have deve loped o r are planning to develo p techno logy standards or technic al approac hes that may support the EHRM seamless ca re strategy. To the extent that underlying third party techno logy is availab le or made available to meet the following timelines. the follow ing interoperab ility so ftware solutions and services shall be delivered under this section: a) By Initial Opera ting Capab ility (IOC) . the Contractor shall provide a software solut ion enabling VA, DoD and comm unity providers who have connec ted to the EHRM to share interactive care plans (ICPs) for Veterans. ICPs will enable co llaborat ive communication between prov iders, and between provide rs and Veterans, in managi ng Veteran ca re. b) Within 24 months of applicable task order award, the Contractor shall provide a software solution enabling VA, DoD and co nnected comm unity providers to comp let e relerra l management activities lor Veterans. c) By IOC, the Co ntractor sha ll provide a software so lutio n enab ling VA to release and cons ume , via on-demand access , a Vetera n's complete longitu dinal health record to and from DoD and co nnected community partners . irrespect ive o l which EHR they use . provided such EHR technology is certified by the Health and Human Se rvices Olfice of the National Coordinato r (ONC) or its successo r. The lo ngitudinal reco rd so lutio n sha ll support Provider-to-Prov ider record sharing, as well as Provider-Vete ran-Provider sharing (Veteran mediated record sharing), includ ing appropr iate consent manageme nt. The bi-directional health information exchange shall maximize use o f disc rete data that supportscontext-drivenclinicaldecisions and informatics. d) Within 24 months of applicab le task o rde r award. the Contract or sha ll provide a softwa re sol ution enabl ing connected VA. DoD and co mmun ity providers co nnected to the EH RM to send and receive Ad mission/Discharge/Transfer notil ications "pus hed" from the provider initiating a Veteran care event to enable proact ive engagemen t by VA care coordinatorswhen notified of a Veteran care event. e) Within 24 months of applica ble task order award , the Contract or will demo nstrate a solution tor ide ntifica tion and management of Veterans at high risk o l suicide . in collaboration with community partners. I) By IOC . the contractor shall provide URL based image access lo the VA. co mmunity and academic partner systems who can su pport the U RL and a viewer to the providers via the health info rmatio n exchange networks . Within 36 months of applicable task order award. the Con tractor shall provide a softwa re solution e nabling VA, DoD and community providersconnected to the EHRM to have nationwideaccess to Veterans' imagingassociatedwith diagnostic tests. g) By IOC , the Contractor shall prov ide a softwa re so lution for multilateral standards -based ingest ion. normalization, storage, a nd export ing of He alth Informat ion Exchange acquired Veteran health information . The Contrac tor shall ensure that the solution provides a computab le dataset for purposes of populat ion health and research analytics. clinical decision support, and workflow integration. h) By IOC , the Contractor shall prov ide the capab ility to co nnect and exchange VA electronic health records via other interoperab le networks , such as . eHea lth Exchange . CareQuality. CommonWe ll Health Alliance , DirectTr ust. National Association for Trusted Exchange by support ing their specifica tions. security and conten t specificat ions. Contractorshall support networkrecordlocator servicesand patientprovider associations as applicable in accordancewith applicable lechnical standards and the Trusted Exchange Framework and Commo n Agreement (TEFCA) . i) By IOC, the Co ntractor shall provide a capab ility for provider collabo ration via secure e-mail us ing the ONC Direct protocol o r future VA-des ignated standard wit hin a Gerne r Millennium EHR workflow contex t. j) With in 36 months o l applica ble task o rde r awa rd. the Contractor shall prov ide a solution for a Softwa re Development Kit (SDK) e nabling standards-based applicat ions (e.g., SMART. FHIR, etc .) integrated with EHRM solut io ns and platforms. k) Gerne r shall de liver annually an Interope rability Plan to the VA o n how it inte nds to meet the object ives established in PWS section 5.10 .4 . The initial plan wi ll be due within 3 months of applicab le TO award . I) The Contractor shall conduct an annua l Interoperab ility Self-Assessment against standards that shall be specif ied by VA, such as those promu lgated by HIMSS o r future standards to be identified by VA. The annua l sell assessment shall report on the state of each data element (e.g ., which are supported in what capacities and in which formats). This w ill help assure standards imp lementat io n cons istency and assure standards compl iance w ith evo lving natio nal standa rds . m) The Contract or shall support Know ledge ln lerope rability by supporting the extension of cli nical co ntent assets such as terminologies , cini cal decis ion support rules, and o rder sets. etc ., to the extent such extensions are consiste nt w ith the model a nd best practices of the co ntrolling natio nal standard . This includes the ability to cu rate. extend. and share that knowledge wit h clinica l partners . This fosters rapid adoption from industry best practices , e .g., clini cal profess ional societies. VA-18-0298-I-000219 Page 278 of 2~m of 1380 RFP review matrix draft_vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) 5.10.4.1 Data Design and Information Sharing In support of the interoperability object ives under t his Sect ion, agreed upon Contractor proprietary information /data model extension points (e.g., ingest ion and record AP ls) may be prov ided to both international and national standa rds designating organ izat ions as described and set forth in an applicable Task Orde r. The Contractor shall provide VA access and usage rights into any underlying proprietary term inology/ code systems for the purpose of enha nc ing nationa l standa rds to address any gaps identified in the EHRM solution . The Contractor shall also make the interope rab ility capabili ties and produc t enhancements d eveloped under this contract availabl e to non-VA Cerner c lients. 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VA anticipates developing a Digit al Health Platform/ Digital Veterans Platform (DVP) t o consolidate critical VA EHR and non-EHR opera t ional systems. The Contractor shall integra te the EHRM to interopera t e w ith DVP, or future state VA platfor m, including the DVP API ga teway or any other methoc des ignated by VA. VA-18-0298-I-000220 2Bof 1380 Page 279 of 2~ RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) tern# ~u lhor LCI Leslie Cooper Modific.ationsto RFP Comment Respon se re, •iewed th e materia l you s.ent regarding the proposed VA EMR con1ract and stat emerlt o f wor k. I ha\ •e one are a of "onccrn regard ing the inte roperab ility of the system with commun ity care prO\•iders. For th e new VA EMRto efficien tly ·ene patienL~. maximize safety an d lowe r medic al cos1s. medical records from 1he mili1ary. VAand commun ity care pro\•ide r's under con tract nn1S[be viewab le i.lla se arnless c::leclronic formal . The language of the con trac t and ·tatement of wo rk do not require lhis of the Cerner system . I reviewed the material you sen t rega rding the proposed VA E..\fR contract and st atement of work. I ha\ 'e one are a of 'Or\ce ni regard ing: the intem pera bility of t.he syste rn wi1h 'Ominun ity care pt0\ •ider's. For th e oew VA EMR 10 efticie,,t ly ·cr\'C patients, maximize safety an d lowe r me dica l costs , medical reco rds from the military. VAand commun ity care prm•ider s unde r con tract must be viewab le in a seam le.c;s e-lectmnic f()rmat. The language of the co,, tract a,,d ·unement of wo rk do not require this of the Cerner system . IDIQPWS Seclion S.10.4: Seaml ess Interope ra bility / Joint Indust ry Outreach: include~ signifteant detail and timeframes on the topic. The entire interope rability section is copied be low this tab le for reference . The object ive or the se int c ro1lcrabilit-ysoluti ons Lsto ad, ·ancc the sta te of tlic art s up1x,rti11g seam less ca re for Vete rans . his ting org anb,ations llrom otin g inte roperabilit y among EHR vendo rs. s uch as The i\.rgon:1ut Project . h.tve devel oped or are planning to devel op tech.nology st.and:ffds or tec hnkal appr o:u.:.hes th:,1 may supporl th e EHRMseamless care str-.il egy. To th e exte nt th;,t u nderlying thi rd p:fft y ec-bnolo gy is a vailable or made availa ble to me e t th e following time Lines, the following interoperability so ftware solution s and sen •ices s hall be deliver ed und er this section : No clta11gerequ;red. rA-NF-T46 Legal Discover,· The s)'stem shall su ppOrt provena nce (chain of custody or owne rship ) and pedi gree {process ing histo r)' how the da ta was produced or incorpora ted) and enab le iden tification, collection . and produ ('.t ion of data accordlng to so urce, custody and ow nership and disp la)' of darn in bus iness, logical. legal or ph)•sical models . 'A·FR-19: Mana ge Clinical Documents. k. Includes the ab ili1y to upload grap hs . colo r images. an d draw ings th at are viewab le in 1he EHRand integ ra1ed with app lica1ions to support co mpar ison of examinatio n fiodiogs O\'er ti,ne . . h,clude the abilit)' 1.0 li11k scan, ,ed Or' other e lectro, ,ic doe:urnen ts 10 a speci fic docu rneot i1, the hea lth reco rd. m. lncludes capturing VAand Non VA Commun it)' Based Scn •ices. DIQ PWS Section 5.5.1: Work.flow Develop ment and Normalization ")The Con tra ctor shall enab le conligurntion of the app licat ion th.tt suppOrts externa l co mm unit)' data without requi ring th e clinician to go to spec ial screens to sec and use reconci led externa l data. By IOCen tr)', the Contrnctor s hall suppOrt incorporat ion of the following externa l comm unit)' data domains . including but not limited to these domain s and sub-dom ains; n 111)' experience using 3 versions of the Cernc r EMR. the Problems records from outside prnvider s are imported as a CCDor CCA Alle.rgies 1le and labe led as "Outside Mat.eriar · with no way to identi fy Home l\•tedications Proce d ur'es - i,,cluding associated reports a,1d with app r'Opr'iate ly filte r'e d CPTcode -s ile co,11erlt or c-0trela1e i,,terna l stud y resu lts wi1h s imllar outside s tudies. For e;.;amplc a fax with a corom:try • lmmuni :uuions angiogram report and a co lonoscop)' report will be included Discharge Summaries n the same ··Outside Material " file. The date on th e Outside Progress Notes Consult Notes ·"fateria l file Le;the dat e of entry into the Cemer fil.·l R. with oo re latio,, to 1he date of the fde content s. These resu l1s are HistOr'Y& Physicals neither indexed nor scarch.tb le. The c lfort re(1uireerability by supporting 1heex1ensio1l of clinical con1en1as.sets such as termino logies. clin.icaldecisio1l suppor1 rules , and ol'der sets. etc .. t.o 1heex1en1such extens ion s arc consistent with 1he model and best prnctices of the contro lkng mlliona l standard, This includes 1he abi lity to cun-He. c~tend. and :;hare that know ledge with clinical par tners. This fos 1ers rapid adop tion fro m industry bes t pra ctices. e.g .. clinic.al professional soc iet ies . 5.10.4.1 Data Design and lnfomrnt ion Sharing 1nsupport of the in1eroperabi li1yobjocti\'CSunder this Section. agreed upon Con1mcto r proprietary information/data mode l extension point s (e.g., ingestio n and record APls) may be provided to both internationa l and national sta ndard s design ating organizations as d escribed and set forth in an app licable Task Order. The Contract o r shall pro\'ide VA access and usage rights into any u nde rlying pro prietary tem1inology / code system s for the purpose of enhanci n g national standa rds 10 ad dre ss any g aps iden1ified in the EHRMsolu tio n . The Contracto r shall also m ake th e interoperab il ity capabi litie.1,an d product enhancements de\ •e loped unde r th is co nt r act a,railab le t o non -VA Cernerc tient s. 5.10.4.2 VA Digilal Ueallh Platfor m/Digital Vetera ns Platform lnt.egra lion VAant icipate s de•.-cloping a Digirnl Hea lth Platfo rm/DigiUtl Vc1erans Platfo rm (DVP) lo cons olidate critica l VA EHR and non- EHR opcrn1ional systems. The ContraclO r s hall integra le the EHR.Mlo interopernlc \~'Ith DVP. o r future s tate VApla tform. including the DVP AP( galeway or an y olhcr me th od des ignate d by VA. VA-18-0298-I-000223 Page 282 of 2~}~ of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) tern# •\utbor SRI omment Step hanie o far, I have no real conce rns. However. ... migh t you be Reel able to help me find the place in the documents. if any, where we might be 'informin g' Cerner o f our expect ations elate d to staff e ngage men t in the assess men t phase? Please a11ow me to share my o nly rea l co ncern (related to mista kes we mad e. and mistakes I hope TI1e VAca n avo id) . Modificationsto RFP "esponse So me of th e respons ibility for yo ur l'.Oncems o n s taff engagement fall cm \IA's man agemen t of tJ1e project. and some falls on Cemc r 's chan ge man age men t and deployme nt process. That No chan ge req11ired. tsaid. the RFPonly ad dresses the Cerner side of the responsi bility for this. He re are so me of the sect io ns in the IDIQ PWS whe re Cerner respo nsibility for workflows/c hange ~ana gemen t/tra ining are discussed . ~ection 5.1 Project Mana ge men t (note this section is very high level. but include s req uirements forCeme r to part icipat e/p lan/s upport many aspec ls of the projec t relale d to )'Our Auestion)Section 5. 1. l: pro vide project management support or: communica tions, project change , organ ization cha nge, and \'alue ~ee l.ion 5.1 .3: provide strate gy and 1>l ann.ing su1lport of: workflows , traiuing . change management, sy nch ron.izat ion with OoD (which may ha\'e a big im1lact on VAand DoO user Once our projects were launched for o ur deployment of Epic. processes) Section S. t.S: pro vide requirements and anal ysis suppor t o n: use cases, change manageme nt, business pro cess modeling , workflow management , s ite•specifi c requirements we bega n to meel rou1.inely with gro ups of use rs. f\S an ~eel.ion S.1.9: provide an implementation Jllan including d.iscussion of dep loym en t, train ing, and change managemen t; empha sis 011 user role de finiti ons; recommen d change examp le, we would mee t with a group of our Oncology ·acuity, to defin e functional require menL'ithat were specific ~ana gemen t ac tivitie.s; par ticipate in business proces s re.ooe ngineering discussion s; anal yze Cerner workflows \ 'S . VA work.flows and pruvide recommendations on process re,..(>n gineering~ ha.ngc mana gement a.nd produ ct configurat ion .ocomp lex chemotherapeu tic order sets and pathways. It wo uld ta ke ho urs, and hours. to 'ge l it righl ·. We would ~ect ion 5. l. ll: Value reporti ng including reporting o n clinical staff experience discuss areas of agree ment , and areas o f d isagree ment. We •o uld de scribe the approac h to reso lving d ifference s. Mos l !Section 5.5: VAEnterpr ise EHRM Base line Prepa ration (this sec tio n has mo re deta ils and is concerned with the enterprise level work Lha l musl be complete d before the first deployment oll:s would apprec iate lhe need for compro mise, but so me ite ca n go live) · peciftc requirements wel'e ass umed to be absolute. And Section 5.5. 1: Work.flowdeve lopmen t and non11alization : so me language o n co nfigura tion of workflO\VSto mee t VA-specific l'e quireme nts; emp hasis on configurat ion to impro\ 'e clinician ·olks were tru ly e ngaged, and o ptimist ic. Howeve r. whe n tCCC.'iS to external da ta . .he ultimat e producl was implemente d, the ·ab solute' ii.ems f:;ection 5 .5.6: Training Plans and Materia ls: training plans a nd materia ls ta ilored to VAe nvironme nt: include s ta ilo ring to t he loca lized business proc ess and standa rd o perat ing procedu res ~y user role •ere so melime s n1issing. And alth ough there \\'ere grea t explanation s for t he cho ices th at had to be made. the end- f:;ection 5 .5.7: Organizational Change Mana ge ment: Lots of informat ion here - probab ly the mosl per tinenl 1.0 you r com men t. users were somet imes srunned by what they perce ived to be ~ect ion 5.6: Wave Plannin g a nd Deployme nt : (this sectio n has so me de l ail on the aspec ts of tJ1e deplo yme nt process focused on use r unders ta nding and input to the workllows being blatant disregard for Lheir req uirements , and ofte n very lisappo inted. [N some cases. it too k weeks (mon ths?) to mplement ed) Ind a rat ional and reaso nable solution - to a problem that ~ection 5.6.2: VACurrent Site Assessme nl : Identify site-spe cific risks/ unique are as: fine-tune the use r adop tio n stra tegy/categorize the leve l of clinical proce ss chan ge ~ect ion 5.6.3: Futur e Stale Review/Wo rk.flowAdop tio n: review ofworkOows/p roc~ses/clinical cont en t with site pe rso nnel no one anticipated . ~ec tion 5.6.4 : Future stat e validation : fdent ify an d implement workflow configurations required for the si te. s there a place where the VA (o r the DoD) was able to !Section 5 .6.9: Training: site specific tra ining; focus o n supe r use r tra ining document how this type o f an assess ment will likely work? ec tion 5.6. 10: Go-Live Read iness Asses sment: Mo,ck go-live test ing: simulate patie nt flow using patient scenar ios: ident ify areas need ing add itiona l training or work.flow practice before goOr 01her such componenls of the sit e a.,;sessmenl pro,cess? ive ~ect ion 5 .6. 12: Pre-dep loyme nt Training: Role•based training 60 days prior t.o go-live with addi1ional ove r-the-shoulder trai_njng 90 da ys after go-live. lsec tion 5.6. 13: Pos t-deploymen t suppo rt : includes assis ting users with workOow suppor t . VA-18-0298-I-000224 Page 283 of 2~}~ of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) SR2 Stephanie Reel I have ident ified no significant issues. As you a ppro priately IW e have no t defined many crystal clear metrics at the IDIQ leve l - primarily because the IDIQcovers so many different to pics thal woul d have different metrics attached to each: hosting. nd ica ted, the document is the summa ry of tho u.•m nds o f ~eployme nt. tra ining , c hange ma nageme nt. Each o f these will have metr ics spelled o ut a long with a Quality Assura nce Surveillance Plan (descr ibin g how VA will monito r the metrics ) t ailored o eac h individual tas k ord e r as they are issued . We do have high level metrics for system ava ilability: 99.9 %, an d for Cemer to prov ide no less tJ1an the co mme rcial service leve l agreeme nt nours of hard wo rk a nd the cont ribu tio ns of ma ny. And, more impor tant ly. you are purchas ing a product. not building hat is provided to all other c usto mers. We also antic ipat e tha t me trics will change over th e IOyear course of th e contrac t as we become sma rter abou t wha t to measure an d how to declare a city. You have captu red much o f wha t I woul d expect to be ·ucce..~s.So. as you state d. there are not many deta iled metrics sta ted at the IDIQ level. nclud ed. l-lowever. there are is a lot of wo rk well unden vay at VAto address yo ur concems - this work is nol documented in 1he RFPsince it is VA respon sibilily, and therefore n ot a Cemer co ntra c1 o so me degree, my co ncerns a.re re lated tot. he a bility t o tem: (note th a t I don' t have much de tail for yo u o n the se acti,~ties since my focus is mostly on 1he co ntra ct with Cemer, a nd not o n how VAwill ma nage th at co ntract ) ensure success or mea sure success, or identify success - or p Set up joi nt govern ance bo ards with the DoD a ilure. I wo rry NOT tha t you hmre n ' t indu cted 1he p Set up e nte rp rise VAgoverna nce over clinical wor kflows/co nfigurations/and issue resol ution Jp propriate leve l o f requireme nts, but that. in fact you have p Set up VA local governance for each site d e ploymen t ndud ed them, but ma y no t be a ble to a.~cert ain th e delivery p Set up VAc.~ommun ication, si te logistic and pre -deploy me nt infrn$truc.~tu re upgrade teams of the requ ireme nts. 01· the sa1isfac1ion of the goals, or the p Docume nt curren t VistA performance levels as a base line ea lization of the de liverab les. I am concerne d that yo u may p Develop value measurement processes not have t he app ro priate gove rn ance proces ses in place, in p Crea te speci fic perfo rmance metr ics for eac h task orde r: (e .g. ·definitio n of d one · for dep lo)'me nt - what bench ma rks ha, re to be achieved before Cern e r can leave th e deploy me nt site. partnershjp with the contractor, to accurn te ly or µser adopt ion rates? CHnkian satis faction? Successful independent testing? etc . - all t his is a underwa y and inco1·porat lng lesso ns learn ed frorn the initial DoD implemen tati on ) ·om prehens ively rea lize that )'O U have. o r have not. receive d what has been ident ified. or wha t is req ull"ed,or wha t is IVAand DoDwill be sh aring a n lnstance of the commercia l Cerner product based in th e Cemer data cen t er conform ing to Cemer commerc ial service leve l agreements. No te that specific : Someway to ens ure that the co ntra ctor isn ·t the o ne dec iding unila tern lly if tJ1e deliverable..~mee t the eq uire men ts as sta ted in 1he wo rk orders? Just thinking o ut oud ?? 5. 10.4 Seam less Interoperabilit y / Join t Industry Outreach VA-18-0298-I-000225 Page 284 of 2~}~ of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) The Contractor is required to collaborale with VAaffiliates. communil'ypartners. EHRproviders, healthcare pl'oviders. and vendors to advance seamless care throughout the health care provide r ma rke t. Seamless ca re will require the creatio n of a n integra ted inpat ie nt and o utpatient so lutio n with so ftware c-0mpo nent s that ha, •e been designed . in tegrated, main t aine d. a nd deployed with a des ign architect ure that a llows for access IO and sharing o f commo n d ata a nd an ena bljng sec urit y framewo rk tha t suppo rts e nd .to-e nd hea lthcare related clinica l and bus iness opera tio ns. Seam less care is the experience patients and pr oviders have moving from task to tas k and encoun ter to encoun t e r within or between organiz at ions such tha t highqua lity deci.'iion s fo nn eas ily a nd co mple te care p lans execu te smoo thly. lnfo1matio n syste ms suppor t th e sc am less acare expe rience by gather ing data, interpr e ting data. prese nting informat ion. and manag ing t asks. Curre ntly, industry lacks specific and unifonn interoperab ility sta ndards to suppon seamJess care benvee n org anizatio ns that employ diffel'e nt EHR systems . TI1e Requireme nts Tracea biliry Ma trix Se<:tion D. Attachment 003. se ts for th spec ific Jnronn atics and Interoperability contr act req uiremen ts. To a ccornplish this. the Comra ctor shall provkte so ftware a nd services to e nab le sea mless care betwee n VA e nco unt ers, enco unt ers with other Gove rnm en t hea llhca re instilu tio ns. and outside e ntit ies throu gh ad vanceme nts in all areas of th e EHR that occur. In additio n. the softw are and servicesshall support the VA designated stru1dards, such as SMARTon FHJRand SMART-enabled applications. or other publ ished sta ndards. tions promoting interoperability amon g EHR The objec tive of these intel'operab ility solution s is to adv ance the stat e of the art supponi ng seaml ess care for Veterans . Ex.isting organiz.i:"l ven dors. suc h as The Argonau t Projec t. have developed or are planning lO deve lop tec hno logy standar ds or techn ical approac hes that may s upport the EHRM sea mless care strategy. To the exle nt that under lying t hLrd party techno logy is availab le o r made m1ailab le to mee t the following time lines , the following interoperability so ftware so lulions and services sha ll be delivered under this section : a) By In itial Operat ing Capa bility (IOC). the Contr acto r shall provide a software so lution e nabling VA. DoD a nd co mmunity prm•ide rs who have co nnect ed to the EHRM to share interac tive care plans (lCPs) for Veterans. ICPs willena ble collabora tive communication between providers. and between providers and Veterans. in manag ing Veteran care. b) Within 24 months of a pplicab le ta sk order awa rd. the Contractor sha l.lprovide a sofl ware so lution ena bling VA. DoD and co nnec ted co mmunity pro\ 1iders to com pie le referra l managemen t act ivities for Vetera ns. c) By IOC.the Contrac t or sha Upro vide a so ftware so lution e na bling VA to release and consume. via on-deman d access. a Vet eran ·s complele longitud inal hea llh record to and from DoD a nd co nnected comm un ity partn ers. irrespec th 1e of which EHR they use. p rovide d such EHR techno logy is ce rtifie d by the Health and Huma n Services Office o f the Nat iona l Coord inator (ONC) or its successor. The lo ngitud inal recor d so lution shall suppo rt Provider- t o-Prov ide r record sharing, as well as Provider-Veteran-Provider sha 1ing (Veteran mediat ed reco rd sharing), including a ppro priat e oonsen l ma nagement. The bi-direc tiona l heal th info nnat io n exchange shall maximize use of d iscre 1e data that supports con texl -drh•e n clinical decisions an d informat ics . d) Within 24 mo nlhs of a pplica ble t as k order awa rd. the Cont ractor sh a ll prov ide a software so lution enab ling co nn ected VA, DoD a nd co mmunity pro\•iders connected to the EHRM to se nd a nd rece ive Admissio n/Discharge/Transfe r not ificati o ns " pushed'' from the pr ovider in itiating a Veleran care event lO e nable proac ti\•e engagemen t by VAcare coord inators when no tified of a Vetera n care eve nt. e) Wit hin 24 mo nth s o f app licab le I.ask o rder award. the Contrac to r will demo nstrate a so lution for iden tificat io n and management of Vet era ns at high risk of su icide . in collaborat ion wit h comm unity par tne rs. f) By IOC, tJ1e contra ct or shall provide URLbased image access to the VA,co mmunity and acade mic pa rtn e r systems who can supporl t he URLa nd a viewer to the prov ide rs via the hea lth info rmation excha nge networks. Wit hin 36 months of applicable t ask order award, the Contrac t or shall provide a sof t ware solution ena bling VA. DoD and commun ity provide rs connecte d to the EHRM to ha\ 'e na tionwide acccs.'i to Vetera ns' imaging associat ed with diagnostic tesL'i. g) By IOC,the Contrac to r shall pro vide a sof twa re solutio n for mult ilaleral stan dards-based ingest io n, nor ma lization, st orage, a nd expo rt ing o f Heahh Informatio n Exchange acqu ired Vete ran hea lth infonnation. The Contractor sha ll e nsure tha l the so lution provides a comput able dat ase t fo r purposes of pop ulation hea lth and research ana lytics. clinical decisio n support. a nd wo rkflow integra tion . h) By IOC, IJ1e Contrac-lo r shall provid e 1he capabil ity to connec t and exc hange VAelectro nic hea hh reco rds ,ria othe r inte roperable net wo rks, such as. e He.all11Exchange . CareQ uality, Common We ll Heal th Alliance. Direc tTrus t. Nationa l Associatio n for Trusted Exchange by suppor ting their spec ifications. sec urily and co nte nt specifica tions. Contract or shall support net work reco rd locator se rvices a nd patie nt provide r associations as app licable in accorda nce with app licab le tech nical sta ndards a nd the Truste d Exchange Framewor k and Common Agree me nt (TEFCA). By IOC, the Contracto r shall provide a capab ility for p rovider collabora tio n via secure e -mail using th e ONC Direct prou x::ol o r futu re VAadesignat e d sta nda rd within a Cerner Millennium EHRworkflow co n1ex1. i) j) Within 36 mont hs of a pplicable tas k order award, the Contr actor shall prm 1ide a so lution for a Soflware Developmen t Kit (SDK) enabling standards -based appl ical ions (e.g .. SJ\•1ART, FHIR. e tc.) integra t ed with EHRM solut io ns and plat fonns . k) Cerne r shall deliver annua lly an Lnl.erope rab ility Plan 10 the VAon how ii. inte nd s to meet the objectives es t ablished in PWS sec t ion 5. 10.4. The initial pla n will be du e within 3 mont hs of applicable TO award. The Contr actor shal l cond uc t an a nnu al Inte ropera bility Self-Assessment aga jnst sta ndard s that sha ll be specified by VA, such as those promul ga ted by HIMSS or futur e sta nd ards lo be identified by VA. The-annua l self assessment sha ll reJX)rt on th e state o f each data element (e.g .. whic h are suppol'ted in wha t capaci ties and in which formats). This wW help assure sta ndar d.~implementatio n co nsis te ncy a nd assure sta nd ard s comp liance with evo lving natio nal sta ndards. I) m) The Contracto r shall sup port Knowledge lnteroperab ility by suppor ting the exle nsion of clin ica l con t e nt assets such as termjnologies , clinical decisio n support rules, a nd orde r sets, etc., to the ext en I such extens io ns are cons ist ent with the model and best practices of the cont rolling national standard. This includes th e ability to curate. ext end. and share that knowledge with clinical part ne rs. l11is fosters rap id ado ption from indu stry bes t:p rac tices, e .g .• dinica l profession a l .'iocietie.'i. 5.10.4. 1 Oat.a Design and lnl'ormation Sharing In suppo rt of the interope rab ility object i\fes under this Sect.ion, agre ed upo n Contractor propr ie tar y infon n at ion/data mode l exte nsion po ints (e .g .. inge.'itio n and reco rd APls) ma y be provkied to both intema1 iona l and nat ional st andard s designat ing organ izations as d escribe d and se t fort h ln an applicable Task Order. 1l1e Contractor shall prov ide VAaccess and usage rights into any und erlying pro prieta ry term ino logy/code sys tems for the purpose o f enha ncing national sta nd ards t o address an y gaps iden tified in the EHRM solut ion. The Cont ractor sha ll a lso ma ke the interoperab ility capab ili1ies a nd prod uct e nhance ments de, relo ped under this co ntract a vailable to non-VA Cemer clie nts. 5. 10.4.2 VADigital Health Platfo rm/Dig ital Vete rans Platform Integration VA anticipates developing a Digital Health Platform/ Digital Veterans Platform (DVP) t o consolidate critical VA EHRand non-EHRoperational systems. The Contractor shall integrate the EHRM to interoperate with DVP, o r futu re sta te VAplatfo rm, including the DVPAPI ga teway or any o the r meth od des igna ted by VA. VA-18-0298-I-000226 2~of 1380 Page 285 of 2~ RFP review matrix draft_ vB.xlsx for Printed Item: 2 15 ( Attach ment 26 of 27) tern # MS I •\utbo r Marc She nna n om ment M odific atio ns t o RFP "es ponse DIQ PWS 5.5.1 : Workflow Develo pment and Normalizati o n: though t that Dr. Cooper made a good case for inser ting pec ific de finj tions an d stan dards on t he mean ing and use of ' interoperab ili ty." especially since that tem1 has as many ) The Contra ctor shall enab le config urati o n of th e application that suppor ts e.xtem al commun ity data wi lho ut requiring the clinic ian to go to special screens to see and use reco nciled meanin gs in the indu st ry as tho se who spea k it. It is so easy ~~te mal data . ByIOC e ntry, the Cont rac tor sha ll supp ort incorpora tion of th e follow ing ex terna l co mmunit y data doma ins. includ ing b ut not limited to these d oma ins a nd sub -doma ins: or the contractor to proceed down a des ign pa th using one I- Pro blems definitio n o r sta ndard while th e use rs will requi re a tota lly I- Alle rgies I- Home Med ica tions different standard. 111at runs the risk o f not being discovered umi l la te r. perh a ps e,,en up to implemen t ation , a Procedures . including associa ted reports a nd with appr opri a tely filtered CPT code.,; ·ery costly resu lt . Perhaps a similar problem (a see m ingly I- Immun ization s t>igpr oblem) that the DOD imple-mentation faces now where Discharge Summ aries Lhe use rs are rebelling . Unfonu natel y. if th is "gap " in Progres s Notes defi nitio n is not d iscovered until IOC. it will be very difficult Cons ulI Notes and \'Cry expensive to fix (a la th e DOD problem) . I agree Histo ry & Physicals with Dr. Coope r, why not se t th e crit ical definit io ns and Operat ive Not.es · tandards in the con trac t (PWS) now and e liminate the 1- Radio logy an d Diagno stic Reports (lnto "Docume nt a tion·· componen t) · hance for an y confus io n o r amb iguity . It will pay dividends ater in tenns o f less argumen ts. be tter injtial desig n. ha pp ier l3y lOC e:-:jt, the Contractor sha ll support inco rporn tion of the foUow ing exter nal commu nit y data d omains, lncludlng bu t not limited t o these do mains and sub -domains : use r co mmun ity. less overa ll cost. better healthca re de livery, I- Resul ts "'IC. The n, with t he stan da rd fully define d a nd se t in th e p Labs original PWS. the mock·up te st \.Viiibe much soo ner in tim e General and much m ore complet e t he firs t time , allowing th e users Pa th ology and Microb iology .oprovide inp ut soo ner and better. e liminating cos tly de sign p Vitals mista.ke.~from th e beginning . The use r commun ity can te ll Radio logy an d Diagnos tic Report s (Into "Diagno stic Repor t" com ponent )• Ima ge s ou today whal is neede d to accomplis h this "next generation" system that will be a mode l for th e countr y a nd DIQ PWS Sectfon 5. 10.4 : Seaml ess In t.e rop erab ilit}' / Joint .Ind ust ry Out reac h includes significant detai l on th e Lopic . The inte ropera bility sec tion is cop ied below this table for ref eren ce . .he future of hea lthca re (as Ms. Ree l env isio ned on the call DJQ PWS secti on 5.5.4 Data Exchange • APllli cati o u Program Int erface (API) Gat eway also i ncludes detail o n the creation of stra tegic open APls. ast night ). Why wo uld you not wa nt to tell th e co nt rac tor the specifics o f tha t no w, in fairn ess to them , the VA, the oatient s and hea Jthcare. so t hey ca n proceed with th at IVA NF-177 : Inter opera bilit y . Data Stan dards: 11le system shaU suppor t the use of the health data standards ident ified in th e VA DoD llealth Infor mat ion Technical Standards Pro file and by ·tand ard fro m da y one or express a ny co ncerns the y ma y he VA DoD l nter agency Clinical Informatics board. inclu ding follow ing com mon data stan dards: Nat io nal ln fonn ati on Exchange Model NIEt.-Llle alth Level 7 HL7: Logical Observation have now instead of in the futu re a fter costly des ign has dent ifie.rs, Name s and Code s LQ[NC;Syste ma t ized Nomene-latu re o f Med ic ine SNOME-0; RxNorm, Me dRT, !CD. CPT, HCPCS, Vetera n Informat io n Model VIM; a nd Hea lth care 1. nfor mat ion occurred ? Why would you no t w ant to be specific in the irechnology Standard s Panel HITSPas well as VA/00D /I PO extensio ns to these standards. ·.o ntrac t to p re \•ent ambigu ity? Dr. Shulkin p ushed back on Dr. Coope r's view as alrea dy accomplished in th e PWS and l\rA-NF-T23: Informa t ics - Care Lnteg:rati on : VAmust be ab le to seam less ly int egra te with HIEand ext ern al-to- EHRshared services t.o pro vide for a seam .less e~pe rie nce aJld to more ·ite d Section 5 (I believe he said sectio n 5. 1.1) of the PWS. ~ffec tively inte grate in communi ty c.ar e efforts . as well a s with o ther part s of VA(e.g .. identity ma nageme nt). This inc ludes but is not limited to the EHRprodu ct abilit y to support external Dr. Coope r. as a ph ysicia n use r and no t a t echn ician, !shared se rvices (SOA services, such as ident ity managem e nt , care plan serv ice, schedu ling, et.c.) ac.cessed via sta ndards-ba sed f\Pls. (Process Cont in uity, Evolut ion, Extens ion ) KSR5 [ NOW+] deferred o n the effec tivene ss of the existing contrac l anguage to others, but commen ted th a l th e CIO of MAYO IVANF-Zl 1: Health Infor m ation Exchan ge : The system shall support VAe lectronic: excha nge of health reco rds via ot he r inte roperabl e netw orks (e.g. CareQua lity. Common We ll Heal th ea d th e contrac t and a lso did no t think it adeq uate ly ~ lliance. DirectTrus t. Nat iona l Associa tion for Truste.lt a Exchange - Application Progrnm lnterrace (API) G>lteway: I) As it relates to FHIR.the Contractor sha ll pro\ •ide an opportu n.ity for jo int co llaboration in pr ioritization of the API roadmap . 111is su pport sha ll occur where VAdata required maps to a No chtmge req 11iretl. FHIR (HL7 Fast Hea lthcar e interoperab ility Reso urce s) resource t hat is currently Lnthe FllIR Roadmap and not pat1 of the software ·s out -of-the -box HIIR resource offerings ) Ensure Substitu table Med ical App lications an d Reusable Techno logies (SMART) complia nce to suppo rt SMARTon FHIRapplica tions . ) Provide standar ds-based f\PI acc.ess (e.g. FHIR) to all pat ien t data from ll1e VA-designaled author i1a1ivedata sources for the patien t 's record wit hin lhe Cont ractor s· producl su ile. DIQ P\\tS Se dion 5.10.4 : Se amless Interop e rab ility / Joint Indu.st ry Outr ea ch ') With in 36 month s of applicable task order award. the Contractor shall provide a solution for a Software Development Kit (SDK) enabling standards-based applications (e.g.• SMART. FHIR. ~le.) integra l ed with EHRM ,•mlutio ns and plat forms . SH5 Stan Huff Suppo rt a " time drive" infrastructure and serv ices . DIQ PWS Se ction 5.1.1: Proj ect ~fana geme nt Support: includes project plann ing. sc hedule managemen t. siLe dep lo yment tracking. qu a liry. risk. perforrna nce and value managemen t. No clw11ge re q11ired . DJQPWS Section 5.1.11: Value and Performance Management Reporting: includes prop osal and monitoring of value objec tives for improved outcomes and con t inuous performance mprovement. throughout the Po P. K}uality Assur an ce Sur veillance Plan Appe ndix A-2: EHRM Non•t'u.nctionaJ Key Pe rform an ce Ind icator s includes 20 areas of tec hnical mea surement along wilh critical success factors and !suggest ed numerical measures. These me t rics will be included as app ro priale in eac h task o rder with VAsurveillance on Cerne r perfo nnance againsl these metric s . SH6 Stan Huff Pro vide a term ino logy se rver that is compliant with th e FHIR erm ino logy Modu le Not e; Cemer notes Lhat it has lhe c apabili ty 10 return term ino logy in a HUR resou rce request. but do not have a FHIRserver for term inology lookup from ou tside today. since th at is some thing that should be hoste.d by an o uts ide gro up. Cerner proposes to work with Argona uts o r the d riving sta nda rds group to set up an d add itional server for lookup if needed . uppo 1t a knowledge repos itory for all kinds o f knowle.dge 111ifacts:CDSlogic. FHIRprofdes. order sets. workflows. etc. IDIQ PWS Section 5. 10.4 : Seaml e.ss Interop erabilit y / Joint Indust ry Outr e ach : I) The Contractor shall conduc t an a nnual Interoperab ility Self-Assessme nt against slandards th at sha ll be specifie d by VA, such as t hose promulga ted by HIMSSo r future standards to be iden tified by VA. The annua l se lf assess ment shall report on the state of each data elemen t (e.g .. which are supported in wha t capac ities and in whic h formats). This will help assu re standards imp leme ntat ion cons istency and assure slandards comp liance with e\•olving naliona l st anda rds . rn) llle Contracto r sh all sup p ort Know ledge Interopera b i lity by suppo rting t he exte n sion of cl i nical co nt ent asset s such as termino logies , cl inical dec isio n support mies, and orde r set s, etc., to th e ex.tent su ch extens ions are co n sistent w ith the mode l a nd best pract ices of t he co nt roll ing nat ional st an d a rd. This inclu des the a b ility t o on, ;~,;~o C'll' ""''"' .,,,.. , .,,nrl ancl ehprf": that 1.,•• •• • •1-...I-- w ith r linira l nara-n,:,,re This; fnet,:,,re ran irl arlnnt inn frn,-n inrl11c.tr ,, h,:,,ct nr"',-, ;,,..,,.. ,:,, r li,,ira l Note: Gerne r w ill p rovide a VA-fac ing repository e-0ntaining ba seline and custom ized worl\l lows as we ll as other a rtifacts in use for the EHRMsolu t ion . Access to these art ifacts w ilt be dr iven by the appropr iate securi ty sensit ivities ass ig ned to each artifact. No clumge req 11ired . ff No cha nge req uired. SH7 Stan SHS Stan Huff IVA is comm itted to se lting. an enterprise -le,reJ se t of common Jy sh,ared workflows across VAand DoD wherever feasible. Joint VA/DoD governa nce boards as well as VAenterprise and local No cluwge req uired . urrently. workflows are hard coded into Lhe app lications . lt t\/AMCboard s are be ing crea ted to ensure that worktlows are standardized as much as feas ible and not customize d to each imp leme ntation . That said. considerable configuration capab ilities makes it near ly impo ss ible to change workflows to p re included in lhecom.merc ial product which can b e used to adj ust workfiows without deviating from t he commerc ial base l.ine. "ccommodate changes Lnclinka l pract ice. SH9 Stan Huff Specify the time frame a fte r a new version o f FHIRis approve d th at Cemer will upgrade its services - o ne year ? Provide the ability for the VA to quickly change workllows . 1No1.e:Ce.rner has priorit ized an additional 40 eng ineers to accelera te FHIRAPls for VAin suppor t of this contract . There is no spec ified timeframe for Cemer upgrades in res ponse t.o new ·HIR\'ersions. No chan ge re qu ired . VA-18-0298-I-000231 Page 290 of 2~1~ of 1380 RFP review matrix draft_vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) SHIO Stan Huff I 0. Support VA or other 3rd party defmed FHIRprofiles No cl,auge require,/. DIQ PWSsection 5.5.4 Data Exchange • Application Program Interface (AP!) Gat eway: includes detail on the creation of strategic open AP!s. a. Use of FHIR profile.~ in mode l dri\ •cn app licat..ion f) As it relates to Fl-UR.the Contract or sha ll prov ide an opportun ity for jo int co llaboration in prior itization of the AP( roadmap . This suppmt sha ll occur where VAdata re quired maps to a f HIR(HL7 Fast Hea lthcare Interoperability Resource s) reso urce that is currently in th e FHIR Roadmap and not part of tJ1esoftwa re's out-of- the-bm: FHIRreso urce offerings development t>. Ability to test con fonnan ce of an application to a specific ·ct of FHIR profile.Ii IVA NF- 177: Int eroperabil ity• Dat a Sta ndard s: The system sha ll support the use of the hea lth data stan dar ds ident ified in the VADoD Health Information Techn ica l Standards Profile and by ~. Services automat ically t est co nfonnan ce to profiles in the emer FHIRservices ,h e VADoD lntera gency Clinical informati cs board. including following common data standards: National lnformat io n Exchange Mcrations: Includes the ab ility to assign med icaJ de vices from all medica l speci alties to an e lec tro nic hea lth record IVA-NF-T78: Criti cal Care: lncludes CriticaJ Care - automate d workflows and docume ntat ion supporting critical care multi-discipHnary teams: Device Connectivity - automated collection of rned ical d ata from med ical de vice.~to ensure right data . right format , right time. 5. J0.4 Seamless Lnt erop e rabilit y / Joint lndustr) ' Outreach The Contrac t or is required t.o collabo rate wilh VAaftiliales , co mmunity partners , EHR prov ide rs, hea lthcare prov iders , a nd vendors to advance sea mless care throughout the healtJ1 ca re provide r market. Sea mless care w ill req uire 1he crea tion o f an int egra ted in patient and o utpat ienl so lulio n with so ftware oomponen1s 1ha t have bee n de.,;igned. in1egra 1ed. maint aine d. and deploye d with a des ign arch itecture that allows for access to and shar ing of comm on d ata and an enabling sec urity framewo rt that suppo rts end-to-e nd hea lthcare rela ted clinica l and bus iness opera t ions. Seamles s care is the expe rie-nce pa tients and provider s have moving from task to task and encoun ter to encoun t er within or be tween o rganizations such that hjghquality decisio ns fon n eas ily and co mplete care plans exec Ule smooth)~. Informa tion systems suppor t th e sea mless-ca.re expe rienc e by gather ing da ta. interpre ting da ta. pre sent ing info rmation , a nd managing ta sks. Cuffe.ntly, industry lacks specific and unifonn inte rope rability sta nda rds to suppon sea mless care bet wee n o rganizatio ns tJ1at employ differe-nt EHR systems. The Requireme nts Tracea biJity Matrix Section D. Attachment 003. sets forth spec ific Informatics and [ntel'Operability con tract requ iremen t s. To accomp lish this, t he Contr actor shall provide so ftwar e and services to enab le sea mless care be tween VAenco unt ers, enco unt ers with o ther Governme nt hea lthcare inst itut io ns. and outside ent ities through ad vance men ts in all areas of th e EHR tha t occur. In additio n, the softw are and services shaJl support the VAdes igna ted stan da rd s. such as SMARTon FHlRand SMART-ena bled app lica tio ns. or other pub lishe d standar ds. The o bjec t ive of these interope rability solut io ns is to adv ance the stat e o f the ai1. support ing seamless care for Vetera ns. Existing orga n.izatio ns promo ting interoperab ility amo ng EHR ven dors. suc h as The Argonaut Projec t. ha\'e deve loped or are planning to deve-lop tec hno logy standa rds or technical approac hes that may support the EHRM seamless care stra tegy . To the extent tha t unde rlying third parl y techno logy is available o r made a\•ailable to mee t the following t im cline.~. the following intero perability so ftware so lutions and services sha ll be delive red under this section : a) By Initial Opera ting Capa bility (IOC). the Contracto r shall provide a soflware solut ion e nabling VA.DoD and co mmunity provide rs who hav e co nnected 10 the EHRM to share in1eract ive care plans (ICPs) for Vete rans . ICPs will ena ble collaborat ive communicatio n be twee n providers . and be twee n providers and Ve1.erans . in ma naging Vetera n ca re . b) Wit hin 24 mo nths of applicable ta sk order award. the Contrac tor s haJl pro"ide a software so lution ena bling VA,DoD a nd co nnected co mmunity providel's to com plete referra l mana gemen t activities for Velera ns. c) By IOC. the Cont ractor sha ll pro\ ide a so ftware so lution enab ling VAto release and cons ume, via on-de mand access . a Veteran' s co mplete longitudinal heah h reco rd to and fro m Oo D and co nnec ted comm u11i1 y partners. irrespe ct ive of which EHR they use. p rovide d such EHRte-ehno logy is cer tified by th e He.alth and Human Services Office o f the Nationa l Coordin ator (ONC) or ils successo r. The lo ngitud inal reco rd so lution shall suppo rt Pro\'ide 1-.to-Prm·ider record sharing. as well a s Provide r-Veteran -Provide r sharing (Vetera n mediat ed reco rd sharing), including appro priate conse nt mana geme nt.. The bi-direct ional hea Jth infon nati o n exchange-shalJ maximize use of d iscre te da ta tha t supports con text-drhre n clinical dec isions an d inform atics. 1 d) Within 24 mo nths of applica ble ta sk orde r award. the Contra ctor sh all pro\'ide a software so lution ena bling co nnected VA. DoD and co mmunity provider s connec ted to the EHRM to se nd and rece ive Admission/Discharge/Transfe r not iftcal ions "pushed" from th e provider initia ting a Vete.ran care eve nt to enable proac ti\'e engagemen t by VAcare coord ina tors whe n notified of a Veteran care eve nt. e ) With in 24 mo nth s o f a pplicable ta sk o rde r award. the Contrn.c to r will de monstrnt e a so lution for iden tificatio n and manage ment of Vet er.in ~ at high lisk of su icid e, in collaborat ion with comm unity partners. f) By IOC, tJ1e l'.Ont rnctor shall prm •ide URL based image alx:ess to the VA. co mmunity and acad emil; partne r systems who c.an suppor t the URL and a viewer to the pro\' ide rs via tJ1e hea lth info rmatio n e:rovider market. Seamlesscare w ill requir e the creation of an inte grat ed inpatient and outpa tien t solut ion with soft ware com ponents th at have been designed . integrated. maint ained, and Will be included in kteployed with a des ign architect ure that allows for access IO and sharing o f commo n d ata and an enab ljng sec urity framew o rk that supp o rts end-to•en d heal thcare re lated clinical and J:,usiness opera tio ns. Seamless care is lhe experience patients and providers have moving from task to task and enco unter to encoun t er within or between o rganizat ions such that highTec/111iclll Dependencies Task Auality decisions fonn eas ily and co mple te c~u e plans execute smoo thly. In formatio n systems supp ort the sea mless-care experie nce by gath ering data. inte rpret ing dat a. present ing nformation. and managing tas ks. Curre ntly, industry lacks specific and unifonn inte roperab ility standa rds to suppor t se amless care between organ izat ions that emp loy differem EHR Order ~ystems. TI1e Requireme nts Traceability Ma trix Seetion D. Attachment 003. sets fort h spec ific lnfonnatic s and Interoperability con tract req uiremen ts. To accomplish this. the Contratto r shall provkle software and services to enable seamless care betwee n VA encou nters, enco unters with o ther Government hea llhca re instilu tio ns. and outside entities through ad vanceme nts in at.I ~reas of the EHR that occur. In addition. the software and servicesshall support the VA designated standards.such asSMARTon FHIRand SMART-enabled applications.or other published ~tandards. INote: Spec ifics on crea.tio n of an interopera bilit y sand bo:\:/testbed will be inl~orporated in the Tec hnical Dependenc ies Task Order which is curre ntly bei ng dra fted . 5. 10 .4 Sea mles..'iInteroperabilit y / Joint Industry Outr each The Contracto r is required to collabo rate wilh VA affiliates. com munity part ners. EHR providers, hea lt hcare providers, and vendors to advance sea mless care throughout the healtJ1ca re provide r market. Seamless ca re w iU requ ire the creation of an integra ted inpatienl and o utpal ient so lution wit h software oompone nls that have been designed. in1egra1ed. maint ained. and deployed with a de sign architectu re that allows for acc.ess to and sharing o f commo n da ta and an enab ling secu rity framewo rk that suppo rts end-to-e nd hea lthcare related clinica l and bus iness operations . Seamless care is the expe 1'ie.nce pat iems and pro viders have moving from task to task and encounter to encoun t er within or between organizat io ns such tJ1athig,hqua lity deci.'iions fonn eas ily and co mplete care p lans execu te smoothly. Information systems suppor t th e seamless-care expe rience by gather ing data, interpre ting data , prese n ting informat ion. and manag ing ta sks. Curre-ntly, industry lacks specific and unifonn int eroperab ility sta ndards to support seamJess care betwee n organ izations that employ diffe1·e-nt EHR systems. TI1e Requirement s Traceability Ma trix Section D. Attachment 003. sets forth spec ific lnfonnati cs and Interoperabil ity contract req uiremen ts. To acco mplish this. the Contractor shall provk le so ftware and services to enable sea mless care betwee n VA encounters , enco unters with o ther Gove-mm ent hea llhca re instilu tio ns. and outside entities through advanceme nts in all areas of the EHR that occur. In addition. the sortware and services shall support the VAdesignated stan dard s. such as SMARTon FH1Rand SMART-enabled applications . or other publish ed standards. The object ive of these intel'operab ility solution s is to advance the st ate of the art suppor ting seamless care for Veterans . Existing organizations promoting interope rab il.ity among EHR vendors. suc h as The Argonau t Project. have developed or are planning lO de velop te chno logy sta ndards o r technical approac hes that may s upport the EHR~·1seam less care strat egy. To the eue nt t hat underly ing third party techno logy is available o r made a\•ailable to mee t the following time lines. the following interoperability so ftware solu1ions and services sha ll be delivered VA-18-0298-I-000237 under this sec tion: Page 296 of 2~1~ of 1380 RFP review matrix draft_ vB.xlsx for Printed Item: 215 ( Attachment 26 of 27) a) By lnj tial Operat ing Capabilit y (IOC). the Contrac tor shall provide a sof tware solut ion enabling VA. DoD and commun ity provider s who have connected to the EHRM to share uHeracti"e c.are plans (ICPs) for Veter ans. ICPs will ena ble c.ollaborat ive commun icatio n between providers. and be twee n providers and Veterans, in mana ging Vetera n l:are. b) W ithin 24 mo nlhs of applicable t ask order award. the Cont ractor shall prov ide a sof tware solutio n enabling VA, OoD and co nnected co mmunity pro\•iders to co mplete refe rral management activitiesfor Veterans. c) By IOC. the Contrnc tor .shall prm •ide a .software so lution e nab ling VA to release and consume, via on~deman d access. a Vete ran 's co mplete longitu dinal healt h reco rd to a nd from Do D and co nnect.ed commu nily pann ers, irrespec ti\•e of which EHR they use, p rovided such EHR techno logy is certifie d by the He.alth and Human Services Office o f the Nationa l Coord in ator (ONC) or its successor. The longitud imll recor d so lution shall support Provider- t o-Provider record sharing. as well as Provider-Veteran-Prov ider sharing (Veteran med iat ed reco rd sharing). including appropriale conse nt management . The bi-directiona l hea lth info1111a tio n exchange shall ma,,:_imize use of d iscrete data thal suppons context-driven clinical dec isions and inform at ics. d) Within 24 months of applica ble t ask order award. the Contractor sha ll provide a so ft ware so lution ena bling co nnected VA,DoD and co mmunity providers connected to the EHRMto se nd and rece ive Admission/Discharge/Transfe r notificatio ns ·' pushed" from the provider in itiating a Veternn care eve nt to enable proact ive engagemen t by VAca re coo rd inators when notified of a Veteran care eve nt. e) Within 24 months of applicable task order award. the Contrac to r will demon strat e a solution for iden tification and rnanagement of Vet era ns at high risk of suicide. in collaborat ion with com mun.ity partners . I) By JOC.d1e contract or shalJ pro\ ide LJRLbased image access to the VA.community and academic pattn er systems who can suppo rl the URLand a viewer t.o the providers via the heaJth infmma tion excha nge netwo rks. Within 36 months of applil·.able t ask order award. the Contrac t or shall pro vide a soft ware solution ena bling VA. DoD and co mmun ity pro\ iders con necte d to th e EHRMto have na1ionwide access to Veterans· imaging assoc ia1ed with diagnostic tests. 1 0 g) By JOC. the Contracto r shall provide a soft w·are solution for mullila1eral standards-based ingestion . normalization. st orage. and exporting of Health Informat ion Exchange acqu ired Veteran hea lth infonn ation . The Contraclor sh all ensure t hat d1e so lution provides a comput able datasel fo r purposes of populat ion heal th and researc h ana lytics. clinical decisio n supporl , and workflow integrat ion. h) By IOC, the Contractor shall provid e the capa biJiry to connect and exchange VAelectro nic he alth records ,1ia other interoperab le netwo rks. such as. e Health Exchange. CareQuality. Common Well Heal th t\lliance, DirectTrust, Natio nal Associat io n for Trusted Exchange by support ing their spec ifications, security and co ntent specifications. Cont ract or shall support network record locator sen •ices and pat ient pro,,ider associa tions as applicable in accordance with applicable technica l standar ds and the Trus ted Exchange Framewor k and Common Agreement (TEFCA). i) By IOC,tJ1e Contra cto r shall provide a capab ility for provider collabora tio n ,,ia secure e-mail using th e ONCDirect p rotoco l o r future VA-designated sta ndard with in a Cerner Millennium EHR workllow co ntext . j) Within 36 months of applicable task orde r awa rd, the Contractor shall provide a so lution for a Software Developmen t Kit (SOK) e nabling standards -based applica tions (e .g., SMART, FHIR. etc.) integrn t ed w i th EHRM solutio ns and platforms. k) Ceme r shaJIdeliver annu ally an lnteroperab iliry Plan to the VAon how it inten ds to meet Lheobjectives es tablished in PWS sect ion 5.10.4 . The initial plan will be d ue within 3 month s of app licable TO award. The Con tractor shall cond uct an annu al Interopera bility Self-Assessment agajnst standards that sha ll be specifie d by VA. such as th ose promulga ted by HIMSS or fuwre standard s to be identified by VA. The annua l self a.s.'iessment shall report on the stal e o f each data element (e.g., which are suppo rted in wha t capacities and in which formaL'i). This will help assure standards implemen tation consistency and assure stand ard s compliance with evolving national sta ndards . I) m) The Contractor shall support Knowledge lnteroperab iJity by suppor ting the extension or clinical cont ent asse ts s uch as term inologies. clinical decision support rules. and order sets. etc .. to the extent such extens io ns are co nsisten I with the model an d be.'il practices of the oontro lling national standard . This include.'i th e ability to curate. ext end. and share that knowledge with clinical partn e rs. TI1js fosters rapid ado ption from industr)' best practkes, e.g .. clinical profess iona l socie ties. 5. 10 .4.1 Data Design and lnform alion Sharing In support of1he imel'Operability obje cti\feSunder this Section, agreed upon Contracrnr propr ie tary info rmation/data model extens ion point s (e.g .. inges tio n and re( ord APls) may be provided to both inte maliona l and nat ional stan da rds designat ing o rganizations as de.'icribed and set forth in an applicable Task Order. The Contraclor shall pro vide VAacce.s.'iand usage rights into any und erlying pro priellU)' l.er mj nology/code systems for the purpose o f enhan cing national sta nda rds t o add ress an y gaps ide nt ified in the EHRMsolution. The Contra ctor sha ll also make the interoperab ility capa bilities and prod uct enhancement s de veloped under this co ntract available to non-VA Cemer client s. 5.10 .4.2 VADigital Health Platform/Digital Veter ans Platform Integration VA anticipa tes de\'elopi ng a Digital Health Platfon n/Dig ital Veterans Plat fo rm (Dl' P) t o co nsolidate cri tical VA EHR and non-EHR ope rati o nal systems . The Con tractor shall i ntegrate the EHRM to interopern te with DVP, or futur e sta te VAplatfonn, including the DVP APIga teway or any o ther meth od des igna ted by VA. VA-18-0298-I-000238 Page 297 of 2~1~ of 1380 Document ID: 0.7.1705.535223-000027 Owner : Blackburn , Scott R. Filename: Special Government Employee - would Marc Sherman consider this? (24).msg Last Modified: Mon Apr 16 22:22:50 CDT 2018 VA-18-0298-I-000239 Page 298 of 2~j~ of 1380 To: Special ~a~'2IB~l~~PrrnB -~~~6~s!i'ff83\V~ .rg'8~J (24).msg for Printed Item: 215 ( Attachment 27 of 27) From: Blackburn , Scott R. Thur 4/5/2018 7 :01 :16 PM Subject: Specia l Gove rnment Employe e - woul d Marc Sherman consider this? Sent: During the 20 14 scandal (after Secreta ry Shinseki was fired and before McDonald came in), Dr. Jonathan Perlin did th is for 60 days. Would Marc be willing to do something similar? http://www.modernhealthcare.com/ article/20140626/NEWS/306269942 http ://www.mod ernhealthcare.com/ article/20 l 40628/MAGAZINE/306289971 http s://www .tennessean.com/story/new s/ health/2014/06/26/veterans-affairs-turns-hca-exec-help/ 11399441/ Scott Blackburn Acting C!O & Executive-in -Charge, Office of Information & Technology Depart ment of Veterans Affairs VA-18-0298-I-000240 Page 299 of 2~lB of 1380 Document ID: 0.7.1705.534733-000002 Owner : Blackburn , Scott R. Filename: [EXTERNAL] Fwd: Contact review (2).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000241 Page 309 of 2~ ~ of 1380 4 To:[EXTER~hl_l~~.n!38B"ftv~,s86W!l:lf~ellrJurRtdRtl~~ Item:243 ( Attac hmen t 2 of 17) From: David Shulkin Sun 3/ 11/2018 4:31 :54 PM Subject: [EXTERNAL] Fwd: Contact review Sent: Scott lets discuss tommorow Sent from my iPhone Begin forwarded message: From: David Shulkin l(b)(G) @ gmail.com> Date: March 11, 2018 at 12:31:22 PM EDT To: Bruce Moskowit zl.!.. (b..:.,; )(:....6 ):....__~---~ =m=a=c=.c=o=m> Cc : Ifitp frenchangel59 .com > (b)(6) mail.com, l.(b-)(-6)-----, Subject: Re: Contact review µl)gma iI.com 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 Moskowit z j(b)(6) @mac.com> wrote: The se are the individua ls to revi ew the contract ; Stephanie Reel CIO - hopkin s Stan Huff CIO- intermiuntain Jonathan Mani sCIO- suttrr Andr ew Kar son MD. - partn ers Leslie Coop er M.D. Clifford Ko M.D .- american college surgeon s Sent from my iPad Bruce Mo skowit z M.D . VA-18-0298-I-000242 Page 310 of 2~\~ of 1380 Document ID: 0.7.1705.534733-000003 Owner: Blackburn, Scott R. Filename: [EXTERNAL] RE: VA EHR (3).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000243 4~of 1380 Page 31 1 of 2~ To:[EXTERtfitJJl&i, VttnWtd~1¥_eigc3r3m~ Cc : From: Sent: Subject : ,.._(b"'"' )(""'"6)....._ ___ Moor head, Quellie U. EOP/WHq(b )(6) Lucas , Jane B. EOP/WHO Mon 2/12/2018 7:54:08 PM [EXTERN AL ] RE: VA EHR 0 .....,.... ...-:WWh J.1?'6p.gov] ; Blackburn, Scott R.[Scott. Blackburn@va.gov] t§>who .eop.gov] Scott, (b)(5) Please let me know if you have additional questions. Thanks! Jane Jane B. Lucas Office of the White House Counsel (202) 456-6980 ja ne.b .lucas@who.eo p.gov From: Liddell , Christopher P. EOP/WHO Se nt : Monday , Februar y 12, 20 18 2:37 PM To: Blackburn, Scott R. Cc:(b)(6) Subject: RE: VAEHR Scott I discussed this with Jane ( copied here) Thanks Chris From: Liddell, Christopher P. EOP/WHO Sen t: Mo nday, February 12, 2018 9:31 AM To: 'Blackburn, Scott R.' Cc: (b)(6) Subject: RE: VAEHR Scott Sorry for slow reply - happy to catch up at so me stage this week Chris VA-18-0298-I-000244 Page 312 of 2~\i of 1380 [EXTERNA L) RE: VA EHR (3).msg for Printed Item: 243 ( Attach ment 3 of 17) From: Blackbum, Scott R. [mailto:Scott .Blackbum @va.gov] Sent: Thursday, Febru ary 8, 2018 9:41 PM To: Liddell, Christopher P. EOP/WHOl,.... (b-)(-6)-------, ~who.eop.gov> Subjec t: VAEHR Chris If you have time possibly early next week, I would love to get your advice relate d to our EHR. The next few weeks will be critical (with budget hearings, discussions with appropr iator s, Vetera n Service Organizations, etc) and we want to make sure we handle everything appropr iately. If you are open to it, I can work with Quellie to find time. Also, I have att ached th e Executive Summary of MITRE's VAinteroperability repor t. Overall very consistent with everything else we see m to be hearing. Scott Scott Blackbum Executive in Charge, Office of Information & Technology US Departm ent of Vetera ns Affairs VA-18-0298-I-000245 Page 313 of 2~\~ of 1380 Document ID: 0.7.1705.534733-000004 Owner : Blackburn , Scott R. Filename: Follow up (4).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000246 4~of 1380 Page 314 of 2~ Toto llowLIPefi}cffi~~gr<8Wlf~ ,,,_ (b_)(_ 6)____ From: Blackburn, Scott R. Se nt: Wed 11/22/2017 11 :49:19 PM Subject: Follow up __, ~~~-MMf;1 ._ (b_)(6_) _ __. ~9mai l.corri.(b __)(_ 6)__ _.@gmai l.com] Bruce/ Marc - thanks again for all your support. We really appreciate what you are doing to bring the best of the healthcare industry to help Veterans/VA. I spoke with David and he gave th e gree n light to move forward. We absolutely want to get this feedback and greatly appreciate th e help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we need to figure out with respect to timing on signing the con tra ct with Congress/budget/funding/etc (e.g., one of the reasons for starting soon is to get in sync with DoD's rollout to leverage synergies; another variable is the Continuing Resolution and timing of when the governme nt budget is finalized which could po ssibly push out to Jan/Feb rather than December as current ly projected ). But we will figure that out. The point being is that we love the idea, do want the feedback, and agree with the logic we discussed on the ph one. We will delay the signing as long as we can to make sure we get this right (the concern is making sure we don't miss the window). If you could rea ch out to the 5 CEOs/CIOs, it would be grea tly appreciated. I will commit to making sure the VAturns around the gap analysis as fast as possible . Do you think it could then be po ssible to shoot for a full da y session in mid-December (week of 11th or 18th )? David had the idea of possibly doing it at the Cerner Innovation Laboratory in Kansas City so we can test/challenge somet hings on the spot. Thanks again for all your support ! I hope you and your families have a grea t Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in -Charge, Office of Informat ion & Tech nology Department of Veterans Affairs VA-18-0298-I-000247 Page 315 of 2~\~ of 1380 Document ID: 0.7.1705.534733-000005 Owner: Blackburn, Scott R. Filename: FW: Getting it right (5).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000248 4~of 1380 Page 316 of 2~ TotW: Getti~M'c!Wor~~-§~ft~'.fs'~8ft'.§'i~8\l\3Blfr@Jcf~g'cM}ach ment5 of 17) From: Windom, John H. Sent: Tue 3/27/2018 1:42:46 PM Subject: FW: Getting it right Sir, I think this recent language request (see below) for inclusion will close the door. Be advised that all comments/questions have been captured in a matrix and properly reconciled. I do not intend to send these out unless requested because I think this recent PWS language is what was being pursued all along. Just keeping you in the loop. I have requested an office call with Mr. Byrne. Please get back to vacationing and thanks for your concern for my Mom. That meant a lot to me. Yr 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 (Yh Floor Suite 5080) Washington, DC20420 John. Windom@va.go v Office: (202) 461-5820 Mobile: (b)(6) Executive Assistant: Ms. (b)(S) Appointments and Scheduling l(b)(6) pnva.gov Office: 202-382-3792 i.;....;..:......;. ____ ......,.. ____ -, From: Windom, John H. Sent: Tuesday, March 27, 2018 9:29 AM To: DJS Cc : Byrne, Jim (OGC); Blackbum, Scott R. Subject: RE: Getting it right Mr. Secreta ry: I am seeking a 30 minute audience with Mr. Byrne to discuss the recently proposed language for insertion in the PWS (section 1.0) so that when I sit at the negotiation tab le with Cerner, I can art iculate that insertion of stated language "closes the deal." This is an important bartering chip to have since I believe the language will spawn Cerner corporate concerns. I have discussed the language with the TACin detail and will defend the language-inse rt ion request vigorously, but simply wanted to close my thought processes/understanding with Mr. Byrne. V/r, John Proposed Language: Please consider this recommended change to PWS Section 1.0 between what is currently the first paragraph and the second paragraph -The project has been awarded via the public interest exception in FAR 6.302-7. The goal of this accelerated award is to deliver a modernized system in the best interests o_fVeterans , their healthcare, and the providers that care for them both inside the VA and in commercial care settings. This award contemplates the provision of services by Cerner Corporation, and accordingly these documents reference VA-18-0298-I-000249 Cerner Corporation and its software and services . However, the Government may determine that in some cases a different source of software and/or services will best support the public's interest in areas such as quality of care, patient Page 317 of 2~\i of 1380 FW: Getting it right (5).msg for Printed.Item: 243 ( Attachment 5pl ,1,]) • • • engagement, operational qrzciency, or mteroperatnlity to 1u{flLlthe goals of Electronic Health Record Moderm zaflon, the Veterans' Choice program, or other reason as the Government may decide. The Government may require performance of part of this award by an alternative source in any such case, in accordance with procurement laws and regulations. This may include, for example, delivery of software or services by another contractor within the Government 's competitive range for the Department of Defense 's DHMSM as provided in the Government's February 19, 2015 notice . 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 (5 th Floor Suite 5080) Washington, DC 20420 John.Windom@va.gov Office: (202) 46 1-5820 Mobile: u.: for Printed Item: 243 ( Attachment 5 of 17) Cc: Hlacl Filename: RE: [EXTERNAL] Follow up meeting (6).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000252 Page 320 of 2~ 5~of 1380 To: RE: [EXTffitj~~ &,>8gR~!ffllb@)~n,co oul Date : November 27 , 2017 at 8 :41: 19 AM EST To: "Blackbum, Scott R."< Scott.Blackbum@va .gov> Cc:l (b)(6) k@gmai l.com" l(b)(6) @gm ail.com> Subject: Re: [EXTERN AL] Follow up meeting Prior to any meetin g we need to know what is not in the contract so we can mak e pro gress : Cerner Contract has to have the respon sibility of 100% connectivity to all EMR platform s for Choice to work Cemer has to have telemedicine built into the sys tem Cerner needs to tract duplicate diagno stic testing Cemer needs to have medication error , trackin g of controlled substan ces and dupli ca te prescr iption monitorin g Cerner needs to tra ct appointment time s betwee n the VA and the Choice Program. Cemer needs to hav e voice recog nition built in These are the basics we need to know prior to writing an agenda and meeting. Thank you Sent from my iPad Bruc e Mo skow itz M.D . On Nov 26, 2017 , at 9:23 AM, Blackburn , Scott R . wro te: Bruce - thank s for the note. I hope you and M arc both had a great Thanksgiving . Sound s good on all below. Let's shoot for the week of De cemb er 11th or December 18th in VA-18-0298-I-000253 Wa shin gton. If the CI Os can get us the list of issues by Dece mber 5th, we will turn around the f gap analy sis quickly. Happy to work with Stephanie, Andrew and M arc on the agenda P age 321 O 2318 253 of 1380 RE: [EXTERN AJ..lFoUow up mee ting (6). msg <$]!!\acted> for Pr ir,ited l\em: 243 ( Attachmen t 6 of 17) cteve lopment - tl1at wou10 oe very hetptu . Scott -----Ori ginal Message- ---From: Bruce Moskow itz.-l(b-l(-6)----------,@ Sent: Friday, November 24, 2017 7:08 PM To: Blackbum , Scott R. Cc:l(bl(6l @gmail.com Subject: [EXTERNAL] Follow up meeting mac.com] I am speaking for myself and it wou ld seem to me that holding it at Cern er wou ld restrain an open honest discussion of what is needed to insure that we have all the key pieces to ha ve the the EMR that we all see as a necessity to provide the end users with all tools necessary to provide quality care. The five CIO' s are very know ledgeable regarding all capabilities of Cemer. I have been an end user of Cemer and know as do the CEO 's the process to quick ly move the agenda forward . We are committed to your adoption of Cerner as the EMR however being rushed into a contract without due diligence on our part would be problem atic. We can be availab le for a meeting in Washington ASAP full y realizing some will need to be on a conference call. I would recommend an agenda that reflects the way forward by both group s and would recommend you allow Step hanie Reel,Andrew Karson and Marc Sherman to assist in the agenda development. Sent from my iPad Bruce Moskow itz M .D. VA-18-0298-I-000254 Page 322 of 2~\i of 1380 Document ID: 0.7.1705.534733-000007 Owner: Blackburn, Scott R. Filename: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu (7).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000255 Page 323 of 2~ 5~of 1380 1g'lrf~lr.'d8~f!~~lri'.IJ-i&~ 3p~Rlf.ff,'e1&t.8~ourke@va.gov] Cc:Re:[EXTEf_mtbla~i&g,~t .dtr¼i~Pc ~r/lWtWtlh lch){6) rnmen r4> ; I~frenchangel59 .com]; (b)(6) gm ail .coml(b)(6) l@g mail.com ] To: Blackburn , Scott . co . lackburn@va.gov ] From: Bruce Moskowitz Sent: Wed 2/28/2018 9:53:27 PM Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + lang uge + Rasu Thank you progre ss 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 add ress the othe r 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 Recog nition. Our new Cemer EHRplatform includes Enterprise Dragon Nuance. VHAcurrently deploys the enterprise version which maintains people voice print and the ClinicalStaff say it works very well (my primary care provider at the Washington VAMedical Center uses it). Cemer will port over the voice prints so the clinicians that use it today will be able to use it tomorrow in Cemer without any rework. The Clinician can use the dictation and other features with voice recognition. How will all ent ered lab dat a, fro m any sour ce, be avail able on a graph Graphs will be available in 2 spots. l. Worktlow MPage lab Component and 2. Results review tlowsheet. When outside labs are mapped we would use the same names as internal and the n they would appea r 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, ove r utilizatio n and me dication duplication/errors at time o f orde ring instead of after the fact Alltests 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 VAwould 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 test s at their initial three sites that have been implemented. Strea mlined SOAP no tes. Yes, the VA/Cemer system will have this. These are provided and will be further configured under VAdirection to meet VAclinician needs. From: Blackburn , Scott R. Se nt: Wedne sday , Februa ry 28, 2018 2:30 PM To: 'Bruce Moskowit z' Cc : DJS; Marc Sherman; O'Rourke, Peter M.; IP ;l(b)(6) @gm ail.com Subjec t: RE: [EXTERNAL] Re: Open API - it is CLOUD + lan guge + 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. VA-18-0298-I-000256 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 f!iMe 324 of 2318 256 of 1380 . h negot1atron. Let me sen you the specmcs wnere we nave tan e to make sure that we got them ng t. Stand by ... Re: [EXTERNAL] Re: Open API - it isa C LOUD + languQe.+ Ra~ 17).msQ .,:extrac.ted>dfodr Printed Uem: 243 I At!Qchment 7 of 17\ Scott From: Bruce Moskowitzl(b)(G) kromac.com ) Sent: Wedne sda y, Februar y 28 , 2018 1:13 PM To: Blackburn, Scott R. l@gmail.com Cc: DJS; Marc She rman; O'Rourke , Pe ter M.; IP;l(b)(6) Subject: Re : [EXTERNAL]Re : Ope n API - it is CLOUD+ languge + Rasu Thank yo u my five CIO' s had looked forward to tar and feathering me if the cloud is not done correct ly! The other issue s are: Vo ice Recognition All entering lab data on a graph from any source Catching test duplication, ove r utili zation and medication duplication /errors at time of ordering not after the fact Streamlined SOAP note s Sent from my iPad Bruce Moskowit z 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 pushback. 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 AP!s 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 other s 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 standard s 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_)_(6-') ________ "'@ ""m =a~c.=c=o= m"-' ] Sent: Tue sday , February 27, 2018 9:29 PM To: Blackbum, Scott R. VA-18-0298-I-000257 la>gmail.com Cc: DJS; Marc She rman; O'Rourke, Peter M.; IP;l(b)(6) Subject: [EXTERNAL) Re: Open API - it is CLOUD + lan guge + Rasu Page 325 of 2~\~ of 1380 Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu (7).msg for Printed Item: 243 ( Attachment 7 of 17) Apo logize for the wording instead of their commercial cloud a cloud based sys tem open To all entities and instead of Amazon it should be all platforms working to acce lerate health care iniati ves Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM , Bruce Moskowitzl (b)(6) @mac.com> wrote: To clar ify further it states their commercia l cloud instead a commerc ial cloud Open to all entities and of equa l 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 Moskowitzl (b)(6) @mac.com> wrote: Thi s is a problem it shou ld say open cloud to all entities not commercia l cloud Second it should be open platform and not just Amazon to all entries working on health care platforms. Sent from my iPh one On Feb 27, 2018, at 6:09 PM, Blackburn, Scott R. wrote: David/Bruce/Marc - here are a few updates: #l) Rasu is all in as far as starting to help right away. I just got off the phone with him. He has UPMCcommjtmen ts rest of this week and is Chai1·manof HiMSSInnovation comm ittee (so we will all be at HiMSStogether next week). However if he needs to come to Washington this week for somethin g, 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 doe sn't have to wait for the IPA pape rwork to come throu gh for him to help. I've at tached Rasu's CVin case you nee d it. #2) The APis are cloud based. Here is the response from our Technical lead ... The Open APls that VAha s access to from Cerner reside in their Commercial Cloud environment . This environme nt is designed to scale to accommodate Cerner's entire remote ho sted customer base. In a recent pre ss release Cerner and Amazon announced that they would be working to ge ther in cooperation to accelerate HealthCare Innovations. #3) Below is the IP language that we negotiated. l(b)(5 ) I (b)(5) VA-18-0298-I-000258 Page 326 of 2~\i of 1380 Re: [EXTERNAL ] Re: Open ARb )(MCls 0 110 • laoa1100 • Pas11 G j _msg for Printed Item: 243 ( Attachment 7 of 17) Of importance: Third rMJTIJparty API deve lopers shall retain their IP rights when their API is used to connect to the Cerner interface , and th ere will be no derivative Contractor IP ownership when third partie s consume Cerner terminology through ope n AP!s. Regarding the question on sharing development with others, see PWS Section 5.5.4 opening paragraph: To accelerate better and more res pon sive se rvice to the Veteran, VA is making a delib era te shift towards becoming a standards (MJT2l -based API driven digital enterprise. A corner stone of this effort is the set up of a strate gic Open API Program, The Digital Veteran Platform API Gateway , that is adopting an outside -in, value -to -busine ss driven approach to create API's that are mana ge d as products to be co nsu med by de velo per s within a nd outside of VA. Finally, Cerner 's response and the final negotiat ion 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 Cemer will provide the VA with access to the data model, share data for analytics freely to 3•·d RFP Section 5.8 address the support to business intelligence and data analytics. Section 5. 10.4.1 supports the patties, increase the amount sharing of Contractor of computab le data proprietary information/data rd exchanged with 3 parties. model extens ion points (e.g., ingestion and record APis) Paneli sts acknowledged this with both international and recommendation is a stretch national standards designating goa l. 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 Cerner ( 5.8: "h) Provide the VA EHRM requeste1 data model, underp inning terminology model , tables, Suggest a 5.10.4. l: definitions, and examples of folly populated Veteran data Contract c files. Provide documentation Knowled: by suppo1 or software that is used for of clinica quality checks and that .illustrate what data elements such as te clinical d, are computable." rules , ord Suggest adding to Sect ion extent su consisten 5.10.4.1: "n) The Contra ctor shall support Knowledge and best Interoperabilit y by supporting contro llh the extension of clinical content standard assets such as terminol ogies, ability to clinica l decision support rules, and share order sets, etc. This include s with clini the ability to curate , extend, fosters ra1 and share that knowledge with industry t clinica l partners. This fosters clinical p1 rapid adoption from industry societies . best practice s, 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 VA-18-0298-I-000259 example data file, and demonstratin~how much of the age 327 of 23.1 i ,~ VI - , __ .., Re: [EXTERNAL] Re: Open API - it is CLrin1i,,,,+tt,,,n~~'-i!ttt""""n-r=nt-i''i"Tt-'M't--------~--- data is computable; provide cost estimates for outside parties to access the data via this mechanism. -Scott VA-18-0298-I-000260 Page 328 of 2~M of 1380 Document ID: 0.7.1705.534733-000008 Owner: Blackburn, Scott R. Filename: RE: [EXTERNAL] Re: VA EHR (8).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000261 Page 329 of 2~e~ of 1380 1 To:RE: [EXTB~~.V~cfiltr~tt'<~8tf~l~8~~?R~OW~~dl>f,Efo'\M1f1J.Vl ~ltWol1i·M~t[ffiomas.Bowman@va.gov] Cc: Zenooz, Ashwini[Ashwini.Zenooz@va.gov] ; Short , John (VACO)[Joh n.Short@va .gov] From: Windom, John H. Sent: Fri 3/23/2018 5:54:36 PM Subject : RE: [EXTERNAL] Re: VA EHR Mr. Blackbum, I went ba ck and re ad Mr. Sherman 's emai l and review ed my notes. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sand box/ tes t platform in advance of contract award. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Moderni za tion (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washin gton , DC 20420 John .Windom@ va .gov Office: (202) 461-5820 Mobil d( b)(6) "--'-':--'--:-"-----:--:-',.----, Executive Assistant: Ms. ! fodrP,ri,ntedlte.rn:2tA3/ Attachment 8 of 17) ID IV PWl'i 5.5.l. worktlow Deve 1opme nt an ~o rmanza 10h: j) The Contractor shall enable configuration of the application that supp orts external communi ty data without requiri ng the clinician to go to specia l scree ns to see and use reconci led exte rnal data . By IOCentr y, the Contractor shall support incorporation of the following external comm unity data domain s, including but not limited to these domains and sub-domai ns: • Problems • Allergies • Home Medications • Procedures - including associa ted reports and with appropria tely filter ed CPTcodes • Immunizations • Discharge Summaries • Progress Notes • Consult Notes • History & Physicals • Operative Notes • Radiology and Diagnostic Report s (Into "Documentation " compo nent) By IOCexit, the Contractor shall suppor t incorporation of the following external community data domains, including but not limited to th ese domai ns and sub-domai ns: • Results oLabs - General - Patho logy and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report" component ) • Images IDIQPWS Sectio n 5.10.4: Seamless Interoperability/ Joint Industry Outreach includes significant detail on the topic. The interoperability sectio n is copied below this table for reference. IDIQPWS section 5.5.4 Data Exchange - Application Program Interface (API) Gateway also includes detail on the creation of stra tegic open APis. VA NF-177 : Interoperability - Data Standards: The system shall support the use of the health data stan dards identified in the VA DoD Health Information Technical Standar ds Profile and by th e VADoD Inte ragency ClinicalInformatics board, including following common data standa rds: National Inform ation Exchan ge Model NTEM;Healt h Level 7 HL7; Logical Observation Identifiers, Names and Codes LOINC;Systema tized Nomenclature of Medicine SNOMED;RxNorm, MedRT, ICD,CPT,HCPCS,Vetera n Information Model VIM;and Healthca re Informati on Technology Standard s Panel HITSP as well as VA/DOD/IPO extensions to the se standards. VA-NF-T23: Inform at ics - Care Integrat ion : VAmust be able to sea mlessly integrate with HIEand external-to-EHR shared services to provide for a seamless experie nce and to more effectively integrate in com munit y care efforts, as well as with other parts of VA (e.g., identity management). This includes but is not limited to the EHRprodu ct ability to support external shared services (SOA services, such as identit y management, care plan service, scheduling, etc.) accessed via sta ndards-based APis. (Process Continuity, Evolution , Extensio n) KSR5 [NOW+) VA NF-Zll: Health Information Exchange : The system shall suppor t VAelectronic exchange of health records via other interoperable networks (e.g. CareQuality, Common Well Health Alliance, DirectTrust, National Association for Trusted Exchange) by suppo rting th eir specifications, security and content specificatio ns 5.10.4 Seam less Inte roperability/ Joint Industry Outreach The Contractor is requ ired to collabora te with VAaffiliates, commu nity par tn ers, EHRproviders, healthcare providers, and vendors to pro vider market. Seamless care will require the crea tion of an integrated inpatient and outpatient solutio n with software compo nen 1 and deployed with a design architecture that allows for access to and sharing of commo n data and an enabling security framework th VA-18-0298-I-000263 and business operations. Seamless care is the experience patients and providers have moving from task to task and encoun ter to enc high-qua lity decisions form easily and comp lete care plans execu te smoothly. Informa tion systems support the seamless-care experie information , and managing tasks. Currently, industry lacks spec ific and uniform inte roperability standards t~~ Sfflffllms care be v• -:263 of 1380 RE: IEXTE B.NAU Re: VA EHR /8) .msri for Printed l!~m· 243 ( Att"-chment 8 of 17) . . . . . etc., to the ex rent such extensions are consistent w1tn the rhooel anct be st practice s of the controlling national standard. This include knowledge with clinical partners. This fosters rapid adoption from industry be st practices, e.g., clinical profe ssio nal societies. 5.10.4.1 Data Desi gn and Information Sharing In support of the interoperability objectives under this Section, agreed upon Contractor proprietary information/data model extens io provided to both international and national standards des igna ting organizations as desc ribe d and se t forth in an applicable Task Orde right s into any underlying proprietary terminolog y/code systems for the purpose of enhancing national standard s to address any gapi shall also make the interoperability capabilities and product enhancements developed under this contract available to non -VACerner 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VAanticipates developing a Digital Health Platform/Di gital Veterans Platform (DVP)to consolidate critical VAEHRand non-EHR opera EHRMto interoperate with DVP,or future state VA platform, including the DVP API gateway or any other method de signated by VA. 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 (5 th Floor Suite 5080) Washington, DC 20420 John.Windom@ va.gov Office: (202) 46 1-5820 Mobile: l(b)(6) Executive Assistant: Ms. l(b)(S) Appointments and Scheduling l(b)(6) ~ va.go v Office: 202-382-3792 I.-----. 1- From: Blackburn, Scott R. Sent: Friday, March 23, 2018 12: 15 PM To: Windom, John H.; Bowman, Thoma s Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary /Deputy' s office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good. com) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackbum, Scott R. Cc: Bruce Moskowit z; DJS Subject : [EXTERNAL] Re: VA EHR Scott , VA-18-0298-I-000265 Than ks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. Page 333 of 2~1~ of 1380 RE: fEXTERNAl.,l Re: VA EHR /.S).rn_sg<~){lracted.- IQI P~nted Item: 243 ( Atta~hm!;)nt 8 of 17), . . I reaa carerur1yyour ema11aooui me er,orcs to worK out tne no1es ra1sea by the experts. You are on the way to k1ck1ngoff an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard; and I know everyone has the goal to build the best next generation system for the veterans' healthcare . However , there were several major issues raised in the calls this week with the technica l and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts . These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer, but I respectful ly don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted ; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has var ious enhancements to today's standard system functiona lity. At a minimum, I heard those experts express the ir opinions that the contract dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non-standard) functiona lity (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambigu ity, disputes and ultimate failure of purpose. The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractua l clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functional ity des ired and have a better understand ing of what is expected of them. Clarity in the contract is a healthy ingred ient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous. You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe . Howeve r, when you substitute this concept for clear, written and defined functiona lity, especially for a design that is expected to be unique in many respects , you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions , but the experts are so united on this point; and together with my historical observat ions of fai lures in nearly identical situations I just see warning flares going off. Scott, I want to see th is project get started , and qu ickly, as much as anyone , but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed , Mar 21, 2018 at 10:19 PM , Blackburn , Scott R. wrote: Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VAOpen APIPledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at Intennountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIRAPis for VAin support of this contract. This will also benefi t Intermountain as Stan was telling us they've only had I 0-15 for their entire company to date. If VA/DoD/Intermountain work toget her we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000266 Per Stephanie 's suggestion, we are going to start moving forward ASAPon formalizing an Advisc,rM~ffl iof%~~ that -:266' of 1380 RE: [EXTERNAL ] Re· VA EHR /8).111sg for.Printed llem:.243 / Allach ment 8 of.j 7l . . . . we can get these 1ns1gmson an ongoing basis. t- fo r Printed Ite m: 243 ( Attach ment 8 of 17) On Wed, Mar 2 1, 201 8 at 8:24 AM , Blackb um , Scott R. wrote: No problem Marc. Thanks for all your help. Very helpful call last night. From: Marc Sherma n l(b)( 6) @gmail.com ] Sent: Wednes day, March 21, 20 18 12:12 AM To: Blackbu m , Scott R. Subject: [EXTERNAL] Re: Stan Hu ff Sco tt I won't be able to joi n the call tomorrow as I have a previo us co mmitm ent that I cann ot move . I will catch up with yo u or Bruce after. Marc Marc Sherman (202) 758-8700 On T ue, Mar 20, 2018, 10:30 PM Bl ackburn , Sco tt R. wrote: Bru ce/Ma rc - thanks fo r introdu cing us to all the expe rts we talked to tonight. It was extremely valuable. We have Stan Huff l(b)(6) fm, Intermountain tomorrow at 10am. I assume you have the calendar invite, but ju st in case it is 1- We have been unable to schedule anything with Dr. Ko (very bu sy calendar). We will trying. Sco tt Scott Blackbum Executive in Charge, Office of Inform ation & Tec hnology US Department of Veterans Affairs VA-18-0298-I-000269 Page 337 of 2~1iof 1380 Document ID: 0.7.1705.534733-000009 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] VA-CIO CALL (9).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000270 Page 338 of 2~ 7~of 1380 To:RE:[EXTffi~~b] ~~i~~j!-(b-'-'i (--'-G )____ From: Blackburn, Scott R. Mon 11/20/2017 10:33:01 PM Sent: Subject: RE: [EXTERNAL] VA-CIO CALL __.~i ffi~'{;l_l~Bhij43 ( Attachment 9 of 17) Dr. Moskowitz, Thank you so much for the note and for all the help/support. I would love to meet you in person. Do you have any plans to be in Washington anytime soon? l thought the call last week was extremely valuable. The experience and wisdom of the participants is such a great asset - we would be fools to not take full advantage of it. l do agree fully that there was a lot to cover in only two hours. I think the moderator was doing the best he could to get as much out of it as possible, while trying to be respectful of the time that so many important people were volunteering. If the 5 CIOswere willing to follow up, perhaps we schedule another session(s) on various deep dive topics? We would abso lutely love that. Just by way of introduction - I jumped into the CIOrole less than 2 months ago when our previous CIO(Rob Thomas) abruptly retired to deal with some personal issues. I am a disabled A1myVeteran (MITROTC).After getting out of service I went to business school and then to McKinsey where I made partner and spent 9+ years there leading large business transformations in industrial clients. Bob McDonald (the former P&G CEOand former Secretary) convinced me to join VAto lead the turnaround after the 2014 Phoenix scandal. From Feb-Sept, I served as Secretary Shulkin' s Deputy until a political appointee was put in place. Then jumped into the CIOrole to work with the team and make sure this gets done. We are still awaiting a permanent CIO. I would be happy to jump on the phone this week to if you would like. Thanks again for your support! Scott Scott Blackburn Acting CIOand Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Fro m: BruceMoskowitz ~l (b~)(~6~ ) _______ __.!@mac.com] Sent: Monday , November 20, 2017 6:02 AM To: Blackburn, Scott R. S ubje c t: [EXTERNAL]VA-CIO CALL Dear Scott: I thou ght the V A-CIO call November 15 to help you wit h practica l indu stry expe rtise relat ing to your proposed Cerne r imp lementation generated some valuable conversation. The participant s were some of th e most highly experienced CI Os with deep EMR background s, togeth er with phy sic ian s who focus on medical error prevention and improving the EMR expe rience. I hope and expect that yo u fo und it of great va lue. Since we have not spo ken before, yo u may not be aware that I am the person who personally recruited the Academic Medical Ce nt ers to provide the VA with advice, int ended to help the VA create and implement a path to fix its care delivery issues, as well as advise on other areas where they can be of value to better veterans' care. I have been a central point for the group and was the co llection point for the participants' post-ca ll debri ef. A lso, for referen ce p urp oses, eac h of the peopl e on yesterday's ca Jl has perform ed flawl ess impl ementat ions of sta te of the art EMR syste m s on be half of their respect ive hea lthca re de livery syste ms, some more than once. Since the ca ll was structured to focus th e di scuss ion on the few dire ct questio ns set forth in your age nd a, and the moderator contro lled the timing of each que stion very tightly, the breadth of the di scuss ionVA-18-0298-I-000271 was somewha t lim ited. As a result, you on ly had the benefit of the experts' advice in the areas that the moderator put on the table ... and the participant' s wa nt to make sure you have the ben efit of their comp lete thought s and feed back . Eve ryone fe lt _.goodabout Page 339 of 2~1A of 1380 RE·1EXTERNAL ] VA-CIO CALL (9).ms g !Qr .Printed ltern: 243 ( Attach me[lt9 of Hl . . . the cl scuss10n on the agenda questio ns ana telt that tne scope ana unpl etnentation issues relating to DOD / VA interoperability were well in hand. Howe ver, some of the participant s' questions raised about other areas left them une asy about the readine ss of the system for implementation or the readiness of the Cemer RFP contract for execution . Based on some of the offshoot discussions, the participant s felt that many non-DOD interoperabi lity solution s have not yet been fully addressed or solved, lead ing to incomplete system plannin g and contracting protections, greatly risking an unsuccessful implementation and large additiona l cost and time overruns. The interoperabili ty with commun ity provider partn ers did not seem to be defined comp letely. Some addition al area s that were identified by the VA and its contractor's participant s and moderator as incomplete in the call are: seamless sharing of Choice partner reco rds, duplicate procedure and medical error prevention, flagg ing mechanisms and implantable device identification, amon g others. Until the design of the system and all function al requirements are identifi ed and comp leted, the participants fear that these as yet undeveloped processes and solution s will re sult in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program. Lastly, at the beginning of yeste rday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process. However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discussion in a two hour phone call with a few questions. Also, as mentioned in the call at various times, the part icipants' did not have access to the RFP contract document , its scope and the contractua l provi sions and protections, a critical part they fee l of eva luating the completen ess of a success ful design and implementation. As such, the participants want to make sure that yeste rday's discussion is understood by everyo ne - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the modera tor, but not as a confirma tion of the project's completeness or readiness for contract execution or implementation, which they believe likely has shortfall s. In general, we liked what we heard, we are honored that you felt our adv ice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implem entation and whether the contract (from the limited discussion) has adequate safeguard s to proceed without risk to the cost and success of the effort. While this was the first time you have spoken to any of these part icipants on the topic of EMR, and maybe on any topic, the participant s wou ld be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomp lete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000272 7~of 1380 Page 340 of 2~ RSbr'At e{~ 5'Qbilty listening sessions (11).msg for Printed Item: 243 ( Attachment 12 of 17) 81 O Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the emai l or a waiver of the attorney-client privilege and/or work product privilege. From: Blackburn , Sco tt R. Sent: Monday, Ja nu ary 29, 2018 11:04 AM To: !(b)(5) [g)who.eop.gov Cc: Fleck , Robert R. (OGC); Byrne , Jim (OGC) ;j(b)(G) Subject: Interoperab ilty liste ning sessions ~------~ Jane, It was a plea sure meetin g you toda y. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob - Chris Liddell asked me (or someone from VA- perhaps Windom or Ash) to attend a few interop era bility listening sessions at the White House (there is one or two of them this Thursday). Jane wanted to loop in with you guys to make sure that makes se nse given where we are with the Cerner contract. It would be just listening mode (from the secon d row). Scott Scott Blackburn Acting CJO& Executive-in-Charge, Office of Information & Technolog y Depart ment of Ve te ran s Affairs VA-18-0298-I-000273 Page 349 of 2~% of 1380 Document ID: 0.7.1705.534733-000013 Owner : Blackburn , Scott R. Filename: RE: SecVA (12).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000274 Page 350 of 2~ 7~of 1380 To: RE: SecV~1~<mfh~~~'b1\ef¾:{grc'dlr~~d~Jr'W~!r:~;kb )(6) Cc: Colli, Jacquel ine[Jacqueline .Colli@va.go;J ;§l( 6 ) @ya 90v) ~va .gov]; Rinchack, Diane[Diane .Rinchack@va.gov]; Llamas, Jose[jose .llamas@va .gov]; Turner, Tanya T.[Tanya.Turner3@va.gov] From: .,_l{b'--'-) ('"'"6.,_) ___ ]_, Sent: Fri 3/9/2018 9:10:18 PM Subject: RE: SecVA Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to trave l, Scott. Sorry about that . Thank you. From: Blackburn , Scott R. Sent: Friday, March 09, 2018 4:09 PM I To: l(b)(6) Cc: Colli , Jacqueline; ~l (b_)(_6_) Subject: RE: SecVA ---------~I Rinchack, Diane; Llamas, Jose; Turn er , Tanya T. Awesome! Thanks so much. _____ From: ,__ (b)(6) ___, Sent: Friday, March 09, 2018 2:50 PM To: Blackbum, Scott ,_ R_.-----------, Cc: Colli, Jacqueline ;l(b)(6) Subject: RE: SecVA ~ Rinc hack, Diane; Llama s, Jose; Turner, Tanya T. Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Frida y, March 09, 2018 2:19 PM To: l(b)(6) l Cc: Colli, Jacqueline;({b) (6) Subject: RE: SecVA ,_____________ _. I'll be there. I'll plan to mimic hi s sched ul e. Sent with Good (w ww.good .com) From~"(b-'-' )(__.6 )____ _, Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline; ,-l (b-)(_6_ ) -------------, Subject: SecVA Scott - just a heads up that boss wants you to travel with him to Mar-A-Largoon Tuesday . He will be meeti ng 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-I-000275 Page 351 of 2~¼ of 1380 Document ID: 0.7.1705.534733-000015 Owner : Blackburn , Scott R. Filename: RE: VACIO advisory support for Gerner contract (14).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000276 Page 354 of 2~ 7~of 1380 To: RE: VACl§le1-~{~WIY!,u..&_~~~ci1,C3.r~tfj9~~Wfi'g~lrS~gf8vf rintedItem:243 ( Attachment 15 of17) From: Sent: Subject: Blackburn, Scott R. Fri 11/3/2017 10:23:29 PM RE: VACIO advisory support for Gerner contract Thanks Avi. I managed to find the other 4 . I will shoot them all an email over the weekend. be included . Thank s for all the sup port. I'll cc you guys too in case you want to Have a great weekend, Scott From: Berkowitz, Avrahm J. EOP/WHO l(b)(6) ~who.eop.gov] Sent: Wedne sday, November 01, 2017 9:33 AM To: Blackburn, Scott R. Subject: [EXTERNAL]RE: VACIO advisory support for Cerner contract Richard D. Daniel ~L(b_)(_6l____ ___, @_k~p_.o_r~g Here is th e first he can help likely with the others - let me know if you need he lp tracking them down - I don ' t have them at the moment From: Blackb urn , Scott R.fmailto:S cott.B lackburn@ va .gov] Sent: Tuesday, October 31, 2017 4:31 PM To: Berkowitz, Avrahm J. E0 P/WH0 l(b)(6)@)who.eop.gov> Subject: FW: VACIO advisory supp ort for Cemer contract HiAvi, Happy Halloween! I just want to follow up on thi s excha nge wit h Jared. Can you help connect us with the 5 CIOs so we can bounce our EHR plan off of them before we go final? Thanks again for all the support! Scott From: Kushner , Jared C. EOPIWHOl(b)(6) @who. eop.gov] Sent: Friday, October 27, 2017 5:36 AM To: Blackburn, Scott R. Cc: Liddell, Christop her P. EOP/WHO; Windom, John H.; DJS; Berkowitz, Avrahm J. EOP/WHO; Dumbauld, Cassidy M. EOP/WHO Subject: [EXTERNAL]Re: VA CIO advisory support for Cerner contract (b)(5) Avi will co nn ec t yo u and schedul e next meeting Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R. wrote: Jared / Chris (b)(5) VA-18-0298-I-000277 r--age000 of 2~117 of 1380 RE: VAC IO advisory support for Cer1wr contract U 4) .JTISQ <~ tracted> for. Printed ltwuf· 243 ( Attachmetit l.5 of 17) co urse we wou10 Jove tor the two or you to Jom as well I you are ava11aule. (b)(5) Scott This is Scott Blackbw-n, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours. I will be accompanied by the Program Executive Officer for VAElectronic Health Record Modernization (PEO EHRM),John Windom, and his key staff members including his Chief Medical Officer (CMO), ChiefTechno logy Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterpa rts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFP with particular emphasis on notable "fail points" EHRdeployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc. to name only a few, but look forward to your thoughts on these and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000278 Page 356 of 2~¼ of 1380 Document ID: 0.7.1705.534733-000016 Owner : Blackburn , Scott R. Filename: RE: VA MEETING (15).msg Last Modified: Mon Apr 16 10:52:44 CDT 2018 VA-18-0298-I-000279 Page 357 of 2~ 7~of 1380 To: RE: VA ~Js~ for Printed Item: 243 ( Attachment 16 of 17) From: Blackburn, Scott R. Tue 11/ 14/20177:15:28PM Subject: RE: VA MEETING Sent: thanks From: DJS Sent: Tue sday, November 14, 20 17 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For th e 5 CIOs who ask, I will tell them th at Bruce is an advisor and exte nsion of the WH/VA team. Is th a t ok to say? From: DJS Sent: Tue sday , November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VAMEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with th e 5 CIOs is Wednesday 3-Spm. On our p re -calls, 2 of th e CIOs have asked about Bruce and wha t his involvement is. I have neve r had any contac t with Bruce, but it seems like a sensi tive relationship. Any advice on ho w to han dle? We invited Jared/Chris from WH as a court esy. I don't think either plan to join, but th ey must have invited Bruce who is now asking a few others to join (see below). Can discuss live lat e r before or after hearin g prep. Scott From: Schnitzer , Jay Jl(b)(6) @mitre.org) Sent: Tue sday, November 14, 20 17 12:47 PM To: Blackburn, Scott R. Cc: Wynn , Jacki e VA-18-0298-I-000280 Page 358 of 2~1i of 1380 Hi Scott, Plea se see the email trail below. Ju st want you aware in case we have people j oining the call wi thout your know ledge or approval. Thanks, Best , Jay Jay J. Sc hnit zer, M .D. , Ph.D. MITRE Fro m : Noga, Jamd(b)(6) @PARTNERS.ORO> Date: Tuesday, Nov 14, 20 17, 11:43 AM To : Karson, Andrew Scott,M.D.l(b)(6) hvmgh.harvard.edu> Cc: Schnitzer, Jay J l(b)(6) @mitre.org> Subject: RE: VA MEETING But do the people hosting the call know you are going to be on the call? I am copying Jay as he is helping coordi nate the call. Jim From: Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11:31 AM To: Noga, James !(b)(6) @PARTNERS.ORO> Subject: RE: VAMEETING Dear Jim, Thank s for the not e. I think that you and I may have a little mis-understanding. I agree that you can of course handle the call, but Gregg and Bruce Moskovitz invited me to the call tomorrow so th at they can have a hands -on clinicians perspective. Bruce and I spoke very briefly (between his patients) a little while ago and Bruce sen t me the below informa tion . I am hoping to touch base with you before the call if that is possible for you. I am tied up in presentations/meetings the rest of the da y, but could speak this eve ning (6pm?) or tomorrow if that is okay with you. (And if needed I will break out of other meetin gs today). Many thank s, Andy From: Noga, James Se nt : Tuesday, November 14, 20 17 11: 16 AM To: Karson, Andrew Scott,M.D j(b)(6) @mgh.harvard.edu> Subject: RE: VAMEETING I had a call with them toda y in prep for tomorrow 's call. I appreciate the offer but I don 't think it is my place to invite you. It needs to come from the VA. From: Karson, Andrew Scott,M .D. Sent: Tuesday, Novem ber 14, 20 17 11: 11 AM To: Noga, James l(b)(S) hvPARTNERS.ORG> Subject: FW: VAMEETING Dear Jim, Given some conflicts that Gregg has being a senior advisor for the VA,Gregg ha s asked me to join the 3pm VAcall tomorrow to be available for the clinician perspective. Would you be up for a 15 minute check -in call with me at some point tomorrow before the VAcall? If so, then I'll reach out to Susan Briggs to get us a time. Many than ks, Andy From : Karson, Andrew Scott,M.D. Se nt: Tuesday , November 14. 20 17 11:06 AM To: 'Bruce Moskowitzl(b)(S) @mac.com> Subject: RE: VAMEETING VA-18-0298-I-000281 Page 359 of 2~1~ of 1380 RE: VA MEETING (15).msg for Printed Item : 243 ( Attachment 16 of 17) Dear Bruce, Man y th anks for th e note . I'll review the below a little later today and I'll be back in to uch. Ma ny th anks and best, Andy From: Bruce Moskowitz l(b )(6) Sent: Tuesday, Novem be r 14, 20 17 10:45 AM To: Karson, Andrew Scott,M.D. l(b)(6) Subject: VA MEETING @mac.com ] l@mgh.harv ard. edu> The call will take place this Wednesday, November 15th between 3:00 PM and 5:00 PM Dial In Number:~l (b_)(6_) ___ ~ Passcode: ..... l(b_)(G_ )_ _. Thank you for your time and involvement. Some backgro und inform ation. These are my concerns as a clinician. Cerner does not have the ability to provide the followin g in the Choi ce Program: Track ing duplicate testing Track ing over utilization by provi ders Tracking duplicate presc riptions and medi cation errors. Tracking tests that were ordered , completed and resu lts go to all physicians involved in the Veterans care Patient notification of critically abnormal results with follow up resolution Arranging appointment follow up between the VA and Private sector Emergency room visits in the privat e sector ability to access records immediately and VA physicia ns notified of emergency care and followup Cemer has no registry to tract what Cardiac and orthopedi c devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Pro vider to the VA patient record with flagging new information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previou s films. For instance a radio logist needs to know if a lung nodule is new or was there previously and the same size. Cardiolo gists need to access cathe terization films in high definition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in real time. Sent from my iPad Bruce Moskowit z M .D. The information in this e-mail is intended only for the person to whom it is VA-18-0298-I-000282 Page 360 of 2~1~ of 1380 RE: VA MEE.TING (j5) ..msg fo~rr inted Item: 243 ( Attachment 16 of 17)th . addressed. lt you be11eve tms e-ma 1 was sent to you m error and e e-ma 11 contains patient information, please contact the Partners Comp liance HelpLine at http://www.partners.org /compliance line . If the e-ma il was sent to you in en-or but does not contain patient inform ation, plea se contact the sender and properly dispose of the e-mail. VA-18-0298-I-000283 8~of 1380 Page 361 of 2~ Document ID: 0.7.1705.534284-000002 Owner : Blackburn , Scott R. Filename: [EXTERNAL] Fwd: Contact review (2).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000284 Page 401 of 2~ 8~of 1380 To:[EXTER~hl_l~~.n!38B"ftv~,s86W!l:lf~ellrJurRtdRtl~~ Item:261 ( Attac hmen t 2 of 15) From: David Shulkin Sun 3/ 11/2018 4:31 :54 PM Subject: [EXTERNAL] Fwd: Contact review Sent: Scott lets discuss tommorow Sent from my iPhon e Begin forwarded me ssage: trogmail.com> From: David Shulkin l(b)(6) Date: March 11, 2018 at 12:31:22 PM EDT (b..:.: )(:....:6 ):..__ _,,=:-;---___Jr m=ac=.c=o=m=> To: Bruce Mo skowit zt.:.. Cc : I~ frenchangel59 .com >, (b)(6) ma il.com, l,... (b-)(-6)-----. ~--~ Subject: Re: Contact review µv gma il.com Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhon e (b_)(_6)_____ On Mar 11, 2018, at 11:02 AM , Bruc e Mo skowit z ~j ~ ~ mac.com> wrote: The se are the individua ls to revi ew the contract ; Stephanie Reel CIO - hopkin s Stan Huff CIO- intermiuntain Jonathan Mani sCIO- suttrr Andr ew Kar son MD. - partn ers Leslie Coop er M.D. Clifford Ko M.D .- american colle ge surgeon s Sent from my iPad Bruc e Mo skowit z M.D . VA-18-0298-I-000285 Page 402 of 2~1~ of 1380 Document ID: 0.7.1705.534284-000003 Owner : Blackburn , Scott R. Filename: Follow up (3).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000286 Page 403 of 2~ 8~of 1380 LI P@i)cffi~~gr<8Wlf41b)(6\°' =· "tt'ffi)Wl~ ~-MMr,'' 1...... (b_)(6_ )_~~ 0d To: Follow 0 " 2 1 1 " gmai l.com',_j (b_)(6 _)_~@ gmai l.com] From: Blackburn, Scott R. Sent: Wed 11/22/20 17 11 :49:19 PM Subject: Follow up Bruce/ Marc - thank s again for all your support. We really appr eciate wha t you are doin g to bring the best of the healthcare industry to help Veterans/VA . I spoke with David and he gave th e gree n light to mo ve forward . We absolut ely want to get th is feedback and greatly apprecia te th e help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we nee d to figure out with respect to timing on signing the con tra ct with Congress/budge t/fu ndin g/e tc (e.g., one of the reaso ns for startin g soon is to get in sync with DoD's rollou t to leverage synerg ies; ano ther variable is the Continuing Resolution and timing of when the government budge t is finalized which could po ssibly push out to Jan/Feb rathe r than December as current ly projected ). But we will figure th at out . The point being is tha t we love the idea, do want the fee dba ck, and agree with the logic we discussed on the phone. We will dela y the signing as long as we can to make sure we get this right (th e concern is making sure we don't miss the window) . If you could reach out to th e 5 CEOs/CIOs, it would be grea tly appreciated. I will commit to making sure the VAturn s aro und the gap analysis as fast as possible . Do you think it could th en be po ssible to shoot for a full day session in mid-December (week of 11th or 18th )? David had the idea of possibly doing it at the Cerner Innovatio n Laboratory in Kansas City so we can test/c hallenge somet hings on the spot. Thanks again for all your support ! I hop e you and your families have a grea t Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in -Charge, Office of Informa tion & Tech nology Depart ment of Vet erans Affairs VA-18-0298-I-000287 Page 404 of 2~1~ of 1380 Document ID: 0.7.1705.534284-000004 Owner: Blackburn, Scott R. Filename: FW: Getting it right (4).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000288 Page 405 of 2~ 8~of 1380 TotW: Getti~M'c!WorW~-§~ft~'.f5'~8ft'.§'1~8\l\3Blfr@J~.1g'cM}ach ment4 of 15) From: W indom, John H. Sent: Tue 3/27/2018 1:42:46 PM Subject: FW: Getting it right Sir, I think this recent language request (see below) for inclusion will close the door. Be advised that all comments/questions have been captured in a matrix and properly reconciled. I do not intend to send these out unless requested because I think this recent PWS language is what was being pursued all along. Just keeping you in the loop. I have requested an office call with Mr. Byrne. Please get back to vacationing and thanks for your concern for my Mom. That meant a lot to me. Yr 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 (Yh Floor Suite 5080) Washington, DC20420 John. Windom@va.go v Office: (202) 461-5820 ...._ Mobile (b)(6) Executive Assistant: Ms. (b)( 6) Appointments and Scheduling !(b)(6) ~ va.gov Office: 202-382-3792 ___________ __ From: Windom, John H. Sent: Tuesday, March 27, 2018 9:29 AM To: DJS Cc : Byrne, Jim (OGC); Blackbum, Scott R. Subject: RE: Getting it right Mr. Secreta ry: I am seeking a 30 minute audience with Mr. Byrne to discuss the recently proposed language for insertion in the PWS (section 1.0) so that when I sit at the negotiation tab le with Cerner, I can art iculate that insertion of stated language "closes the deal." This is an important bartering chip to have since I believe the language will spawn Cerner corporate concerns. I have discussed the language with the TACin detail and will defend the language-inse rt ion request vigorously, but simply wanted to close my thought processes/understanding with Mr. Byrne. V/r, John Proposed Language: Please consider this recommended change to PWS Section 1.0 between what is currently the first paragraph and the second paragraph -The project has been awarded via the public interest exception in FAR 6.302-7. The goal of this accelerated award is to deliver a modernized system in the best interests o_fVeterans , their healthcare, and the providers that care for them both inside the VA and in commercial care settings. This award contemplates the provision of services by Cerner Corporation, and accordingly these documents reference VA-18-0298-I-000289 Cerner Corporation and its software and services . However, the Government may determine that in some cases a different source of software and/or services will best support the public's interest in areas such as quality of care, patient Page 406 of 2~1i of 1380 FW: Getting it. right (4).msg for Printed.Item: 261 ( Attachment 4pf ,\5) . . . engagement, operational qrzciency, or mteroperatnlity to 1u{flLlthe goals of Electronic Health Record Moderm zaflon, the Veterans' Choice program, or other reason as the Government may decide. The Government may require performance of part of this award by an alternative source in any such case, in accordance with procurement laws and regulations. This may include, for example, delivery of software or services by another contractor within the Government 's competitive range for the Department of Defense 's DHMSM as provided in the Government's February 19, 2015 notice . 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 (5 th Floor Suite 5080) Washington, DC20420 John.Windom@va.gov Office: (202) 46 1-5820 Mobi le: l,l;; (b:...!..: )(..:..6 )'-- ---r.:--::-::-:---, Executive Assistan t: Ms. (b)(G) - Appointments and Scheduli ng !(b)(6) l@va.gov Office: 202-382-3792 From: DJS Sent: Tues day , March 27, 2018 7:50 AM To: Windom , John H. Cc: Byrne, Jim (OGC) Subject: FW: Getting it right John- can you help craft a response to this Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Sunday , Marc h 25, 2018 9:37:38 AM To: DJS Subject: RE: Getting it right I'm not sure if you read Marc's response to mine yet. Or if so, what your thought s are on it. I fear we are still talking past each other. If he/others were to come back with specific counter language to the language in the contract then we would certainly consider that (that is the level we are working at right now) . But we aren't getting that nor do I see us getting that without Marc or anything else really digging into the details of our contract. We are way beyond the high level philo sophy. Let me know and I' ll direct the team. In Bahamas now and only have connectiv ity sporadically , but back in US (Florida/Disney) tomorrow morning. Back in the office on Thur sday. Sent with Good (www.good .com) From: DJS Sent: Sunday, March 25 , 2018 12:08:17 PM To: Byrne, J im (OGC) VA-18-0298-I-000290 Page 407 of 2~1i of 1380 FW: GeJtinQit rioht 14lmsg for Printed Item: 261 ( Attachment 4 of 15) Cc: Hlacl Filename: RE: [EXTERNAL] Follow up meeting (5).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000292 Page 409 of 2~ 9~of 1380 To: RE: [EXTffi~~bl Cc : From: Sent: Subject: ~8g'fi~ffi&b)f6t@cngfrf'a~!~smyn :261 ( Attach ment 5 of 15) oxlrnclod l(b)(6) (g>gmail.com(b)(6) Blackburn, Scott R. Mon 11/27/2017 3:42:51 PM RE: [EXTERNAL] Follow up meeting gmail.com] Thank yo u Bruce. Very helpful. From: Bruce Moskowi t~._ (b...,.. )(__ 6_) ,.....,.....--.....,....--,--------' @mac.com ] Sent: Monday , November 27, 2017 10:18 AM To: Blackbum, Scott R. Ccj (b)(6) @gmail.com Subject: Fwd: [EXTERNAL] Follow up m ee ting I should point out thi s wou ld be ideal functionality req uirement s of any EMR contract if not part of what has been reviewed by the VA we need to discuss the se points further since they are der ive d from the previou s meeting point s made by the CIO' s and we can again cover them in the agenda Sent from my iPad Bruce Moskow itz M.D. Begin forwarded message: From: Bruc e Mo skowit z ¥b)(6) @mac.com> Date : November 27, 2017 at 8 :41: 19 AM EST To: "Blackbum , Scott R."< Scott.Blackbum@va .gov> Cc: l(b)(G) l@gmail.com" l(b)(6) @gmail.com> Subject: Re: [EXTERN AL] Follow up meeting Prior to any meetin g we need to know what is not in the contract so we can mak e pro gress : Cerner Contract has to have the respon sibility of 100% connectivity to all EMR platform s for Choice to work Cemer has to have telemedicine built into the sys tem Cerner needs to tract duplicate diagno stic testing Cemer needs to have medication error , trackin g of contro lled substan ces and dupli ca te prescr iption monitorin g Cerner needs to tract appointment time s between the VA and the Choice Program. Cemer needs to have voice recog nition built in The se are the basics we need to know prior to writing an agenda and meeting. Thank yo u Sent from my iPad Bruce Mo skow itz M.D . On Nov 26, 2017 , at 9:23 AM, Blackburn , Scott R . wrote: Bruce - thank s for the note. I hope you and M arc both had a great Thanksg iving. Sounds good on all below. Let's shoot for the week of De cemb er 11th or December 18th in VA-18-0298-I-000293 Wash ington. If the CI Os can get us the list of issues by Dece mber 5th, we will turn around the f gap analysis quickly. Happy to work with Stephan ie, Andrew and M arc on the agenda P age 410 O 2318 293 of 1380 RE: [EXTERN AJ..lFoUow up mee ting (5). msg <$]!!\acted> for Pr ir,ited l\em: 261 ( Attachmen t 5 of 15) cteve lopment - tl1at wou10 oe very hetptu . Scott -----Ori ginal Message- ---From: Bruce Moskow itz .-l (b-)(_6_ ) ---------. Sent: Friday, November 24, 2017 7:08 PM To: Blackbum , Scott R. Cc: l(b)(6) Wgm ail.com Subject: [EXTERNAL] Follow up meeting @mac.com ] I am speaking for myself and it wou ld seem to me that holding it at Cern er wou ld restrain an open honest discussion of what is needed to insure that we have all the key pieces to ha ve the the EMR that we all see as a necessity to provide the end users with all tools necessary to provide quality care. The five CIO ' s are very know ledgeable regarding all capabilities of Cemer. I have been an end user of Cemer and know as do the CEO 's the process to quick ly move the agenda forward . We are committed to your adoption of Cerner as the EMR however being rushed into a contract without due diligence on our part would be problem atic. We can be availab le for a meeting in Washington ASAP full y realizing some will need to be on a conference call. I would recommend an agenda that reflects the way forward by both group s and would recommend you allow Step hanie Reel,Andrew Karson and Marc Sherman to assist in the agenda development. Sent from my iPad Bruce Moskow itz M .D. VA-18-0298-I-000294 Page 411 of 2~1i of 1380 Document ID: 0.7.1705.534284-000011 Owner : Blackburn , Scott R. Filename: RE: SecVA (10).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000295 Page 435 of 2~ 9~of 1380 1 To: RE:SecV~1~8ltmfh~~~'b1\ef¾:{grc'dlr~~d~Jm~!r:~;l{b) 1 /6i j <;) @va.~ov) Cc: Colli, Jacquel ine[Jacqueline .Col li@va.go~i ;@:)(6) @va .gov]; Rinchack, Diane[Diane .Rinchack va.gov]; Llamas, Jose[jose .llamas@va .gov]; Turner, Tanya T.[Tanya.Turner3@va.gov] From: ~(b_)(_6)__ ~ Sent: Fri 3/9/2018 9:10:18 PM Subject: RE: SecVA Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to trave l, Scott. Sorry about that . Thank you. From: Blackburn , Scott R. Sent: Friday, March 09 , 2018 4:09 PM I To~ (b)(6) Cc: Colli , Jacqueline~J(b _)_(6_) __________ Subject: RE: SecVA ____.I Rinchack, Diane; Llamas, Jose; Turn er , Tanya T. Awesome! Thanks so much. _____ From: .__ (b)(6) ___, Sent: Friday, March 09, 2018 2:50 PM To: Blackburn, Scott ,... R_.___________ Cc: Colli, Jacqueline ~(b)(6) Subject: RE: SecVA __, Rinc hack, Diane; Llama s, Jose; Turner, Tanya T. I Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Frida , March 09 , 2018 2:19 PM To: (b)(6) Cc: Colli, Jacqueline; "-(b-'-)(.;_6") __________ Subject: RE: SecVA __. I'll be there. I'll plan to mimic hi s sche dul e. Sent with Good (w ww.good .com) From: l(b ..._)(_6_) ___ ___. Sent: Friday, March 09 , 2018 2:18:28 PM To: Blackburn, Scott ,R_. ------------. Cc: Colli, Jacqueline; l.__ (b_)(_6_ ) __________ Subject: SecVA _, Scott - just a heads up that boss wants you to travel with him to Mar-A-Largoon 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-I-000296 Page 436 of 2~1i of 1380 Document ID: 0.7.1705.534284-000012 Owner : Blackburn , Scott R. Filename: RE: Update (11).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000297 Page 437 of 2~ 9~of 1380 To: RE: Upd~Mdbm~ J8~'na ~JdAfl'ffirl8g~a.~1ti)chmen t 12 of 15) From: Blackb urn , Scott R. Tue 3/27/2018 12:19:27 PM Subject: RE: Update Sent: Hmm. Have you spoken to the Secre tary direc tly yet? I wrote him about Marc Sherm an's email but he didn ' t respond. No t sure where his hea d is at. I don ' t understand why ogc wo uld meet him without you. It kill s me how we don ' t trust each other and try to work point to point through the Secre tary. Sent with Good (www.good.com) From: Windom, John H. Sent: Tuesday, March 27, 2018 6 :34: 17 AM To: Blackbu m, ScottR. Subject: Update Sir There was a meetin g between Shulkin and the attorneys (Byrne and Fl eck) last week that I was not invited to. This is the language propo sed for inclu sion in the con tract fo llowing that mee tin g. Does the inclu sion of thi s language clo se the deal? Befo re nego tiatin g with Ce rner, I need to under stand weat her it clo ses the dea l. I discuss with the TAC thi s mornin g . Ju st received yeste rday eve . Thank you. John John , Ref erence is made to the note I sent you last Wednesday whe reby I mentioned that OGC (Mr. Byrne) wanted to re view our RFP. Mik e Kray c inov ich recently shared th e following OGC reque sted PWS change (italicized) presumab ly as a res ult of that review : Plea se consider this recommend ed change to PWS Sect ion 1.0 betwee n what is currently the first paragrap h and the seco nd para graph -The proje ct has been awarde d via the public interest exce ption in FAR 6.302-7. The goa l of this accelerated award is to deliver a mode rnized sys tem in the best interests of Veterans, their hea lthca re, and the provid ers that care for them both inside the VA and in co mmer cial care settings . Thi s awa rd contemplat es the provi sion of serv ices by Cerner Corpora tion, and accord ingly these document s referen ce Cerner Corporation and its softw are and ser vices. However, the Gov ernm ent may determin e that in so me cases a diff erent source of softw are and/or servi ces will best support the public's int erest in areas such as qua lity of care, patient engagement, operationa l efficiency, or interop erab ility to fulfill the goa ls of Electronic Health Recor d Mo derni zation , the Veterans' Choi ce program, or other reason as the Governme nt may dec ide. The Go vernme nt ma y requ ire perfor mance of part of this awa rd by an alternativ e so urce in any such case , in acco rdance with procureme nt laws and regulation s. Th is may includ e, for exa mpl e, delivery of software or services by another contracto r w ithin the Gove rnment 's comp etitiv e range for the D epartment of Defense ' s DHMSM as provide d in the Government's February 19, 2015 notic e. Sent with Good (www.goo d.com) VA-18-0298-I-000298 9~of 1380 Page 438 of 2~ Document ID: 0.7.1705.534284-000013 Owner : Blackburn , Scott R. Filename: RE: VACIO advisory support for Gerner contract (12).msg Last Modified: Mon Apr 16 10:52:34 CDT 2018 VA-18-0298-I-000299 Page 439 of 2~ 9~of 1380 To: RE: VACl§le1-~{~WIY!,u..&_~~~ci1,C3.r~tfj9~~Wfi'g~lrS~gf8vf rintedItem:261 ( Attachment 13 of15) From: Sent: Subject: Blackburn, Scott R. Fri 11/3/2017 10:23:29 PM RE: VACIO advisory support for Gerner contract Thanks Avi. I managed to find the other 4 . I will shoot them all an email over the weekend. I'll cc you guys too in case you want to be included . Thank s for all the sup port. Have a great weekend, Scott From: Berkowitz, Avrahm J. EOP/WHO [mailto:avi@who.eop.gov] Sent: Wedne sday, November 01, 2017 9: 33 AM To: Blackburn, Scott R. Subject: [EXTERNAL]RE: VACIO advisory support for Cerner contract Richard D. Daniel ~L(b_)(_6_ ) ____ .....r-@k~p_.o_r~g Here is th e first he can help likely with the others - let me know if you need he lp tracking them down - I don ' t have them at the moment From: Blackb urn , Scott R.fmailto:S cott.B lackb urn@ va.gov] Sent: Tuesday, October 31, 2017 4:31 PM To: Berkowitz , Avrahm J. E0 P/WH0E6J@who.eop.gov> Subject: FW: VACIO advisory support for Cemer contract HiAvi, Happy Halloween! I just want to follow up on thi s exchange wit h Jared. Can you help connect us with the 5 CIOs so we can bounce our EHRplan off of them before we go final? Thanks again for all the support! Scott From: Kushner , Jared C. EOP/WHOl(b)(6) @who.eop.gov] Sent: Friday, October 27, 2017 5:36 AM To: Blackburn, Scott R. Cc: Liddell, Christopher P. EOP/WHO; Windom, John H.; DJS; Berkowitz, Avrahm J. EOP/WHO; Dumbauld, Cassidy M. EOP/WHO Subject: [EXTERNAL]Re: VA CIO advisory sup port for Cerner contract (b)(5) Avi will conn ec t you and schedul e next meeting Sent from my iPhone On Oct 27, 2017, at 1:56 AM, Blackburn, Scott R. wrote: Jared / Chris (b)(5) VA-18-0298-I-000300 r ct\:jt: '+'+I.J 01 2 ~biof 13ao RE: VAC IO advisory support for Cer1wr contract (.12).JTISQ<~ tracted> for. Printed ltwuf· 261 ( Attachmetit l_3 of 15) cour se we wou10 Jove tor the two or you to Jom as well I you are ava11aule. (b)(5) Scott This is Scott Blackbw-n, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours. I will be accompanied by the Program Executive Officer for VAElectronic Health Record Modernization (PEO EHRM),John Windom, and his key staff members including his Chief Medical Officer (CMO), ChiefTechno logy Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterpa rts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFP with particular emphasis on notable "fail points" EHRdeployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc. to name only a few, but look forward to your thoughts on these and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000301 Page 441 of 2~b~ of 1380 To: RE: VA ~Js~ for Printed Item: 261 ( Attachment 14 of 15) From: Blackburn, Scott R. Tue 11/ 14/20177:15:28PM Subject: RE: VA MEETING Sent: thanks From: DJS Sent: Tue sday, November 14, 20 17 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For th e 5 CIOs who ask, I will tell them th at Bruce is an advisor and exte nsion of the WH/VA team. Is th a t ok to say? From: DJS Sent: Tue sday , November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VAMEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with th e 5 CIOs is Wednesday 3-Spm. On our p re -calls, 2 of th e CIOs have asked about Bruce and wha t his involvement is. I have neve r had any contac t with Bruce, but it seems like a sensi tive relationship. Any advice on ho w to han dle? We invited Jared/Chris from WH as a court esy. I don't think either plan to join, but th ey must have invited Bruce who is now asking a few others to join (see below). Can discuss live lat e r before or after hearin g prep. Scott From: Schnitzer , Jay Jl (b)( 6 ) @mitre.org) Sent: Tue sday, November 14, 20 17 12:47 PM To: Blackburn, Scott R. Cc: Wynn , Jackie VA-18-0298-I-000302 Page 443 of 2~b~ of 1380 Hi Scott, Plea se see the email trail below. Ju st want you aware in case we have people joining the call without your knowledge or approval. Thanks, Best , Jay Jay J. Schnitzer, M .D. , Ph.D. MITRE From: Noga, Jame~(b)(6) k@PARTNERS.ORG> Date: Tuesday, Nov 14, 20 17, 11:43 AM To: Karson, Andrew Scott,M.D.i{b)(6) l@mgh.harvard.edu> Cc: Schnitzer, Jay J l(b)(6) @mitre.org> Subject: RE: VA MEETING But do the people ho sting the call know you are going to be on the call? I am copying Jay as he is helping coordi nate the call. Jim From: Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11:31 AM To: Noga, James J(b)(6) l@PARTNERS.ORG> Subject: RE: VAMEETING Dear Jim, Thank s for the not e. I think that you and I may have a little mis-understanding. I agree that you can of course handle the call, but Gregg and Bruce Moskovitz invited me to the call tomorrow so th at they can have a hands-on clinicians perspective. Bruce and I spoke very briefly (between his patients) a little while ago and Bruce sen t me the below informa tion . I am hoping to touch base with you before the call if that is possible for you. I am tied up in presentations/meetings the rest of the da y, but could speak this evening (6pm?) or tom orrow if that is okay with you. (And if needed I will break out of other meetings today). Many thank s, Andy From: Noga, James Sent: Tuesday, November 14, 20 17 11: 16 AM To: Karson, Andrew Scott,M.D. l(b)(6) ~mgh.harvard.edu> Subject: RE: VAMEETING I had a call with them toda y in prep for tomorrow 's call. I appreciate the offer but I don 't think it is my place to invite yo u. It needs to come from the VA. From: Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11: 11 AM To: Noga, James j(b)(6) l@PARTNERS.ORG> Subject: FW: VAMEETING Dear Jim, Given some conflicts that Gregg has being a senior adviso r for the VA,Gregg ha s asked me to join the 3pm VA call tomorrow to be available for the clinician perspective. Would you be up for a 15 minute check -in call with me at some point tomorrow before the VAcall? If so, then I'll reach out to Susan Briggs to get us a time. Many than ks, Andy From: Karson, Andrew Scott,M.D. Sent: Tuesday, November 14, 2017 11:06 AM To: 'Bruce Moskowi tz' l(b)(6) l@mac.com> Subject: RE: VAMEETING VA-18-0298-I-000303 Page 444 of 2~b~ of 1380 RE: VA MEETING (13).msg for Printed Item: 261 ( Attachment 14 of 15) Dear Bruce, Many th anks for the note . I'll review the below a little later today and I'll be back in to uch. Ma ny th anks and best, Andy From: Bruce Moskowitz l(b)(6) @mac.com] Sent: Tuesday, Novem be r 14, 20 17 10:45 AM To: Karson, Andrew Scott,M.D. !(b)(6) @mgh.harvard.edu> Subject: VA MEETING The call will take place this Wednesday, November 15th between 3:00 PM and 5:00 PM 6 Dial In Number:.... l(b_)(_ l____ Passcode: ~l (b_)(5_l _ _, _, Thank you for your time and involvement. Some backgro und information. These are my concerns as a clinician. Cerner does not have the ability to provide the following in the Choice Program: Track ing duplicate testing Track ing over utilization by provi ders Tracking duplicate prescriptions and medication errors. Tracking tests that were ordered , completed and resu lts go to all physician s involved in the Veterans care Patient notification of critically abnormal results with follow up resolution Arranging appointment follow up between the VA and Private sector Emergency room visits in the private sector ability to access records immediately and VA physicia ns notified of emergency care and followup Cemer has no registry to tract what Cardiac and orthopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Provider to the VA patient record with flagging new information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radio logist needs to know if a lung nodule is new or was there previously and the same size. Cardiolo gists need to access catheter ization films in high definition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in real time. Sent from my iPad Bruce Moskowitz M.D. The information in this e-ma il is intended only for the person to whom it is VA-18-0298-I-000304 Page 445 of 2~biof 1380 RE: VA MEE.TING (j3) ..msg fo~rr inted Item: 261 ( Attachment 14 of 15)th . addressed . lt you be11evetms e-ma1 was sent to you m error and e e-ma11 contains patient information, please contact the Partners Compliance HelpLine at http://www.partners.org /compliance line . If the e-ma il was sent to you in en-or but does not contain patient information , plea se contact the sender and properly dispose of the e-mail. VA-18-0298-I-000305 0~of 1380 Page 446 of 2~ Document ID: 0.7.1705.533736-000004 Owner : Blackburn , Scott R. Filename: RE: Contract Language (4).msg Last Modified: Mon Apr 16 08:55:50 CDT 2018 VA-18-0298-I-000306 Page 498 of 2~ 0~of 1380 f To: RE: Cont'S~rtd8~?'tfu'\Hf189 J.fc1!Affff&'~rfd~lrg l~\?i?gz;J llachment 4 of6) Cc : Windom, John H.[John.Windo m@va.gov ] From: Blackburn, Scott R. Sent: Mon 4/2/2018 1 :40:53 PM Subject : RE: Contract Language Morris, Genevieve (OS/ONC/IO) IL.. (b.....: )(.....:6 )____ ...J'l @~hh_ s~.g~o_ v l don 't think I have a phone number for her, but will let you know if I can find it. Fro m: Sandoval, Cam ilo J. Sent: Monday, April 02, 2018 9:03 AM To: Blackburn, Scott R. Cc : Windom , John H. Subject: RE: Contract Language Scott,Do you have Genev ieve's work email address and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you, Camilo From: Blackburn, Scott R. Sent: Sunday, April 01, 2018 6:28:05 PM To: Sandoval, Camilo J. Cc: Windom, John H. Subject: RE: Contract Languag e Yep, I know Genevieve. She is good. Will give it some thought. Is she detailed in to VHA I assume? From: Sandova l, Camilo J. Se nt: Sunday , April 01 , 20 18 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Cont ract Language Excellent, I' II touch base with Windom tomorrow mornin g. Also , there ' s someone by the name of Genevieve Morri s from the Office of National Coordinator (ONC ) jo ining the VA tomorrow on a 120 day detai l. I believe she will be helping us review the contract as well, at least with regards to interoperability , and already working with the EHR team. Do you know (of) her ? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond ju st reviewing the Cerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperabilit y? Camilo From: Blackburn, Sco tt R. Sent: Sunday , April 0 1, 2018 4: 38:47 PM To: Sa ndova l, Camilo J. Cc: Windom , John H. Subject: RE: Contract Language VA-18-0298-I-000307 Not sure we did. John? Page 499 of 2~b~ of 1380 •• .RE: Cont ract LqrliJUaQe.(4l.m sg tor P,i,nted Item: 277 ( Attac;hment 4 of £L . What he might oe ralK1ngauout 1s tne teeaoack trom tHe ca lls we hact 'L weeks ago . I believe John and team have crea te d a th oro ugh matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback a nd then understoo d how we were reconci ling that feedback). There was also the language that we received via OGC. I'll leave it to John to weigh in. Fro m: Sandoval, Camilo J. Sent: Sunday, April 0 1, 2018 7:35 PM To: Blackburn, Scott R. Cc : Windom , John H. Subject: Re: Contrac t Language Scott, I just spoke with Bruce Mo skowit z regarding where things are with EHR and he mentioned you recently rece ived language provid ed by several CIOs (Leslie Coope r, Stan Huff , Stepha nie Reel, Jonathan Manis). Could you kind ly forward me those emails and documents? I believe it was in regards to interoperability. Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000308 Page 500 of 2~ 0~of 1380 Document ID: 0.7.1705.533632-000004 Owner : Blackburn , Scott R. Filename: RE: Contract Language (4).msg Last Modified: Mon Apr 16 08:55:50 CDT 2018 VA-18-0298-I-000309 Page 526 of 2~ 0~of 1380 f To: RE: Cont'S~rtd8~?'tfu'\Hf189 J.fc1ffirfff&'~rfd~lrg l~\?i?~Mllachment 4 of6) Cc: Windom, John H.[John.Windom@va .gov] From: Blackburn, Scott R. Sent: Mon 4/2/2018 1 :40:53 PM Subject: RE: Contract Language Morris, Genevieve (OS/ONC/IO ~L~b)(_6)____ ___J>~-h_h_ s~.g~o_ v l don 't think I have a phone number for her, but will let you know if I can find it. From: Sandoval, Camilo J. Sent: Monday, April 02, 2018 9:03 AM To: Blackburn, Scott R. Cc: Windom , John H. Subject: RE: Contract Language Scott,Do you have Genevieve' s work email address and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you , Camilo From: Blackburn, Scott R. Sent: Sunday, April 01, 2018 6:28:05 PM To: Sandoval, Camilo J. Cc: Windom, John H. Subject: RE: Contract Language Yep, I know Genevieve. She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandova l, Camilo J. Sent: Sunday , April 01 , 2018 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Contract Language Excellent, I' II touch base with Windom tomorrow mornin g. Also, there's someone by the name of Genevieve Morri s from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detai l. I believ e she will be helping us review the contract as well, at least with regards to interoperability , and already working with the EHR team . Do you know (of) her ? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond ju st reviewing the Cerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperabilit y? Camilo From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 4: 38:47 PM To: Sandoval, Camilo J. Cc: Windom , John H. Subject: RE: Contract Language VA-18-0298-I-000310 Not sure we did. John? Page 527 of 2~\i of 1380 •• .RE: Contract LqrliJUaQe.(4l.m sg tor P,i,nted Item: 284 ( Attac;hment 4 of £L . What he might oe ralK1ngauout 1s tne teeaoack trom tHe ca lls we hact 'L weeks ago . I believe John and team have crea te d a th oro ugh matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback a nd then understoo d how we were reconci ling that feedback). There was also the language that we received via OGC. I'll leave it to John to weigh in. Fro m: Sandoval, Cam ilo J. Sent: Sunday, April 01, 2018 7:35 PM To: Blackburn, Scott R. Cc : Windom , John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regardi ng where things are with EHR and he mentioned you recently received language provided by several CIOs (Les lie Coope r, Stan Huff , Stepha nie Reel, Jonathan Manis). Could you kind ly forward me those emails and document s? I believe it was in regards to interoperability. Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000311 1 Page 528 of 2~ ~ of 1380 T o : Follow LIPefi}cffi~~g~8Wkzl(b)(6) t From: d It Se nt: Blackburn, Scott R. Wed 11/22/2017 11:49:19 PM Subject: Follow up ?O'l ( - ♦♦~wm.~.MMf;ll._ (b_ )(6_)_ __.~gmai l.cor11 ~(b_)(G _) -~ ~gmai l.com] Bruce/ Marc - thank s again for all your support. We really appr eciate what you are doin g to bring the best of the healthcar e industry to help Veterans/VA. I spoke with David and he gave th e gree n light to mo ve forward. We absolut ely want to get this feedback and greatly appreciate th e help. The only caveat is that we move as aggressively/quickly as possible. There are still a few things we need to figure out with respect to timing on signing the con tra ct with Congress/budget/funding/etc (e.g., one of the reasons for startin g soon is to get in sync with DoD's rollout to leverage synerg ies; another variable is the Continuing Resolution and timing of when the government budget is finalized which could po ssibly push out to Jan/Feb rather than December as currently projected ). But we will figure that out . The point being is that we love the idea , do want the feedback, and agree with the logic we discussed on the phone. We will delay the signing as long as we can to make sure we get this right (the concern is making sure we don't miss the window). If you could reach out to the 5 CEOs/CIOs,it would be grea tly appreciated. I will commit to making sure the VAturn s around the gap analysis as fast as possible . Do you think it could th en be po ssible to shoot for a full da y session in mid-December (week of 11th or 18th )? David had the idea of possibly doing it at the Cerner Innovation Laboratory in Kansas City so we can test/challenge somet hings on the spot. Thanks again for all your support ! I hop e you and your families have a grea t Thanksgiving. Scott Scott Blackburn Acting CIO & Executive-in -Charge, Office of Informa tion & Tech nology Department of Vet erans Affairs VA-18-0298-I-000312 Page 600 of 2~\~ of 1380 Document ID: 0.7.1705.527498-000006 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] Follow up meeting (6).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000313 l Page 605 of 2~ ~ of 1380 ~frf'a~!~smyn : To:RE:[EXT's} A ~ :fi~!M(b)(6}°' 302 ( Attachment 6 of 17) Cc: (b)(6) gmail.com1(b)(6) @gmail.com] From: Blackburn, Scott R. Sent: Mon 11/27/2017 3:42:51 PM Subject: RE: [EXTERNAL] Follow up meeting 1 1 1 Thank yo u Bruce . Very help ful. From: Bruce Moskowitz ~l (b~)(~6)~ _______ Sent: Monday , November 27, 2017 10:18 AM To: Blackbum, Scott R. Cc:!(b)(6) @gmail.com S ubj ect: Fwd: [EXTERNAL] Follow up meeting @mac.com ] I should point out thi s wou ld be ideal functionality req uirement s of any EMR contract if not part of what has been reviewed by the VA we need to discuss the se points further since they are der ive d from the previou s meeting point s made by the CIO' s and we can again cover them in the agenda Sent from my iPad Bruc e Moskowitz M.D. Begin forwarded message: From: Bruc e Mo skowit z l(b)(G) @mac.com> Date: November 27, 2017 at 8 :41: 19 AM EST To: "Blackbum, Scott R."< Scott.Blackbum@va .gov> Cc: l(b)(6) l@gmail.com"l(b)(6) @gmail.com> Subject: Re: [EXTERN AL] Follow up meeting Prior to any meetin g we need to know what is not in the contract so we can mak e pro gress : Cerner Contract has to have the respon sibility of 100% connectivity to all EMR platform s for Choice to work Cemer has to have telemedicine built into the sys tem Cerner needs to tract duplicate diagno stic testing Cemer needs to have medication error , tracking of controlled substan ces and dupli ca te prescr iption monitorin g Cerner needs to tract appointment time s between the VA and the Choice Program. Cemer needs to have voice recog nition built in The se are the basics we need to know prior to writing an agenda and meeting. Thank you Sent from my iPad Bruce Mo skow itz M.D. On Nov 26, 2017 , at 9:23 AM, Blackburn , Scott R . wrote: Bru ce - thank s for the note. I hope you and M arc both had a great Thanksgiving. Sounds good on all below. Let's shoot for the week of De cemb er 11th or December 18th in VA-18-0298-I-000314 Washington . If the CI Os can get us the list of issues by Dece mber 5th, we will turn around the f gap analysis quickly. Happy to work with Stephanie, Andrew and M arc on the agenda P age 606 O 2318 31it of 1380 RE: [EXTERN AJ..lFoUow up mee ting (6). msg <$]!!\acted> for Pr ir,ited l\em: 302 ( Attachmen t 6 of 17) cteve lopment - tl1at wo u10 oe very hetptu . Scott -----Ori ginal Message- ---,....----------, From: Bru ce Mo skow itz l(b)(6 ) Sent: Friday, November 24, 2017 7:08 PM To: Blackbum, Scott R. cc:l (b)(6 ) ~gm ail.com Subject: [EXTERNAL] Follow up meeting @mac.com] I am speaking for myse lf and it wou ld seem to me that holdin g it at Cern er wou ld restrain an open honest d iscussion of what is needed to insure that we have all the key pieces to ha ve the the EMR that we all see as a necessity to pro vide the end users with all tool s necessary to provide quality care. The five CIO' s are very know ledgeable regarding all capabilities of Cemer. I have been an end user of Cemer and know as do the CEO 's the pro cess to quick ly mov e the agenda forward . We are committ ed to your adoption of Cerner as the EMR however being ru shed into a contra ct without du e diligence on our part would be problem atic. We can be availab le for a meeting in Wa shington ASAP full y realizing some will need to be on a conference call. I wou ld reco mmend an age nda that reflects the way forward by both group s and wou ld reco mmend you allow Step hani e Reel,Andrew Karson and Marc Sherman to ass ist in the agenda deve lopment. Sent from my iPad Bruce Mo skow itz M .D. VA-18-0298-I-000315 Page 607 of 2~\~ of 1380 Document ID: 0.7.1705.527498-000008 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] Re: VA EHR (8).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000316 Page 614 of 2~m of 1380 1 To:RE: [EXTB~~.V~cfiltr~tt'<~8tf~l~8~~?R~OW~~dl>f,s38iM1M ~ltWol1i·M~t[ffiomas.Bowman@va.gov] Cc: Zenooz, Ashwini[Ashwini.Zenooz@va.gov] ; Short , John (VACO)[Joh n.Short@va.gov ] From: Windom, John H. Sent: Fri 3/23/2018 5:54:36 PM Subject : RE: [EXTERNAL] Re: VA EHR Mr. Blackbum, I went ba ck and re ad Mr. Sherman 's emai l and review ed my notes. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sand box/ tes t platform in advance of contract award. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Moderni za tion (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washin gton , DC 20420 John. Windom@va .gov Office: (202) 461-5820 Mobile: !/b)/6) I Executive Assistant: Ms. l~ (b-)(-6)-~I - Appointments and Scheduling l(b)(6) ~ va. gov Office: 202-382-3792 From: Windom, John H. Sent: Friday, March 23, 2018 1:47 PM To: Blackbu rn , Scott R. ; Bowm an, Thoma s Cc: Zenooz, Ashwini; Short, John (VACO) RE: [EXTERNAL] Re: VA EHR Subject: Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type . We have provisions in the EHR contract to insert technology as we, the VA, as well as to incorporate evolving technology and standards. The DVPacquisition is our bridge to the use of APis (gateways), FHIR,etc . We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the rece nt phone call to sto p Marc Sherman, et. Al's parade of nation al interoperability objectives as not feasible at this juncture "anywhere," but included as part of our overall interoperability strategy that includes the DVPacquisition/strategy. We are committed to establishing the interoperabilit y test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition , I belie ve Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman do es not understand the culture of VAor the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHRModernization effort. He appears to be more of a "big bang " theor y guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulation s/policies (e.g. cybersecurity, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology , innovation opportunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities (IOC)process and the judicious issuan ce of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to reco gnize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas, not mor e words in the contract. VA-18-0298-I-000317 V/r , John Page 615 of 2~\~ of 1380 l;U;:JEKT.EBI\IAL l Re; VA EHR /fil.m sri fodrP,ri,ntedlte.rn:3tQ2/ Attachment 8 of 17) ID IV PWl'i 5.5.l. worktlow Deve 1opme nt an ~o rmanza 10h: j) The Contractor shall enabl e configuration of the application that supp orts external communi ty data without requiri ng the clinician to go to specia l scree ns to see and use reconci led exte rnal data . By IOC entr y, the Contractor sha ll support incorporation of the following external comm unity data domain s, including but not limited to these domains and sub-domai ns: • Problems • Allergies • Home Medications • Procedures - including associa ted reports and with appropria tely filter ed CPT codes • Immunizations • Discharge Summaries • Progress Notes • Consult Notes • History & Physicals • Operative Notes • Radiology and Diagnostic Report s (Into "Docume ntation " compo ne nt) By IOC exit, the Contractor shall suppor t incorporation of the following external community data domains, including but not limited to th ese domai ns and sub-domai ns: • Results oLabs - General - Patho logy and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report" component ) • Ima ges IDIQPWS Sectio n 5.10.4: Seamless Interoperability/ Joint Industry Outreach includes significant detail on the topic. The interoperability sectio n is copied below this table for reference. IDIQPWS section 5.5.4 Data Exchange - Application Program Interface (API) Gateway a lso includes detail on the creation of stra tegic open APis. VA NF-177 : Interoperability - Data Standards: The system shall support the use of the health data stan dards ide ntified in the VA DoD Health Information Technical Standar ds Profile and by th e VADoD Inte ragency Clinical Informatics board, including following common data standa rds: National Inform ation Exchan ge Model NTEM;Healt h Level 7 HL7; Logical Observation Identifiers, Name s and Codes LOINC;Systema tized Nome nclature of Medicine SNOMED;RxNorm, MedRT, ICD,CPT, HCPCS,Vetera n Information Model VIM; a nd Healthca re Informati on Technology Standard s Panel HITSP as well as VA/DOD/IPO extensions to the se standards. VA-NF-T23: Inform at ics - Care Integrat ion : VAmust be able to sea mlessly integrate with HIEand external-to-EHR shared services to provide for a seamless experie nce and to more effectively integrate in com munit y care efforts, as well as with other parts of VA (e.g., identity management). This includes but is not limited to the EHRprodu ct ability to support external share d services (SOA services, such as ide ntit y management, care plan service, scheduling, e tc.) accessed via sta ndards-based APis. (Process Continuit y, Evolution , Extensio n) KSR5 [NOW+) VA NF-Zll: Health Information Exchange : The system shall suppor t VAelectronic exchange of health records via other interoperable networks (e.g. CareQuality, Common Well Health Alliance, DirectTrus t, National Association for Trusted Exchange) by suppo rting th eir specifica tions, securit y a nd co ntent specificatio ns 5.10.4 Seam less Inte roperability/ Joint Industry Outreach The Contractor is requ ired to collabora te with VAaffiliates, commu nity par tn ers, EHRproviders, healthcare providers, and vendors to provider market. Seamless care will require the crea tion of an integrated inpatient and outpatient solutio n with software compo nen 1 and deployed with a design architecture that allows for access to and sharing of commo n data and an enabling security framework th VA-18-0298-I-000318 and business operations. Seamless care is the experience patients and providers have moving from task to task and encoun ter to enc high-qua lity decisions form easily and comp lete care plans execu te smoothly. Informa tion systems support the seamless-care experie information , a nd managing tasks. Currently, industry lacks spec ific a nd uniform inte roperability standards t~{>Sfflffllms care be v• -318 of 1380 RE: IEXTE B.NAU Re: VA EHR /8) .msri for Printed l!~m· 302 ( Att"-chment 8 of 17) . . . . . etc., to the ex rent such extensions are consistent w1tn the rhooel anct be st practice s of the controlling national standard. This include knowledge with clinical partners. This fosters rapid adoption from industry be st practices, e.g., clinical profe ssional societies. 5.10.4.1 Data Desi gn and Information Sharing In support of the interoperability objectives under this Section, agreed upon Contractor proprietary information/data model extens io provided to both international and national standards des igna ting organizations as describe d and se t forth in an applicable Task Orde right s into any underlying proprietary terminolog y/code systems for the purpose of enhancing national standard s to address any gapi shall also make the interoperability capabilities and product enhancements developed under this contract available to non -VACerner 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VAanticipates developing a Digital Health Platform/Di gital Veterans Platform (DVP)to consolidate critical VAEHRand non-EHR opera EHRMto interoperate with DVP,or future state VAplatform, including the DVPAPI gateway or any other method de signated by VA. John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Modernization (PEO EHRM) Special Advisor to the Under Secreta ry for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washington, DC20420 John.Windom@ va.gov Office: (202) 46 1-5820 Mobile11b)/6) I Executive Assistant: MsJ(b)(G) I- Appointments and Scheduling l(b)(6) ~ va.go v Office: 202-382-3792 From: Blackburn, Scott R. Sent: Friday, March 23, 2018 12: 15 PM To: Windom, John H.; Bowman, Thoma s Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary /Deputy' s office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good. com) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackbum, Scott R. Cc: Bruce Moskowit z; DJS Subject : [EXTERNAL] Re: VA EHR Scott , VA-18-0298-I-000320 Than ks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. Page 618 of 2~1i of 1380 RE: fEXTERNAl.,l Re: VA EHR /.S).rn_sg<~){lracted.- IQI P~nted Item: 302 ( Atta~hm!;)nt 8 of 17), . . I reaa carerur1yyour ema11aooui me er,orcs to worK out tne no1es ra1sea by the experts. You are on the way to k1ck1ngoff an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard; and I know everyone has the goal to bui ld the best next generation system for the veterans' healthcare . However , there were several major issues raised in the calls this week with the technica l and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts . These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer, but I respectful ly don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted ; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has var ious enhancements to today's standard system functiona lity. At a minimum, I heard those experts express the ir opinions that the contract dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non-standard) functiona lity (they articulate it much better than I). Failing to express this type of definitiona l clarity in the contract is an invitation to ambigu ity, disputes and ultimate failure of purpose. The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractua l clarity allows the Contractor to understand TODAY what is expecte d so that today it can confirm its agreement to provide the full functional ity des ired and have a better understand ing of what is expected of them . Clarity in the contract is a healthy ingred ient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe . Howeve r, when you substitute this concept for clear, written and defined functiona lity, especially for a design that is expected to be unique in many respects , you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions , but the experts are so united on this point; and together with my historical observat ions of fai lures in nearly identica l situations I just see warning flares going off. Scott, I want to see th is project get started , and qu ickly, as much as anyone , but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Jus t my opinion and food for thought as you make your decisions . Marc On Wed , Mar 2 1, 20 18 at 10:19 PM , Blackburn , Scott R. wrote: Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VAOpen APIPledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at Intennountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIRAPis for VAin support of this contract. This will also benefi t Intermountain as Stan was telling us they've only had I 0-15 for their entire company to date. If VA/DoD/Intermountain work toget her we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000321 Per Stephanie 's suggestion, we are going to start moving forward ASAPon formalizing an Advis~ -M~ITT'Yiof%~~ that -32 'I' of 1380 RE: [EXTERNAL ] Re· VA EHR /8).111sg for.Printed llem:..302 / Allach ment 8 of.j 7l . . . . we can get these 1ns1gmson an ongoing basis. t- fo r Printed Ite m: 302 ( Attach ment 8 of 17) On Wed, Mar 2 1, 201 8 at 8:24 AM , Blackb um , Scott R. wrote: No problem Marc. Thanks for all your help. Very helpful call last night. From: Marc Sherma nl (b)(6) hµgmail.com ] Sent: Wednes day, Marc h 21, 20 18 12:12 AM To: Blackbu m , Scott R. Subject: [EXTERNAL] Re: Stan Hu ff Sco tt I won't be able to joi n the call tomorrow as I have a previo us co mmitm ent that I cann ot move . I will catch up with yo u or Bruce after. Marc Marc Sherman (202) 758-8700 On T ue, Mar 20, 2018, 10:30 PM Bl ackburn , Sco tt R. wrote: Bru ce/Ma rc - thanks fo r introdu cing us to all the expe rts we talked to tonight. It was extremely valuable. We haveStanHufffromIntermountain tomorrow at 10am. I assume you have the calendar invite, but ju st in case it is 1- l(b)(6) I We have been unable to schedule anything with Dr. Ko (very bu sy calendar). We will trying. Sco tt Scott Blackbum Executive in Charge, Office of Inform ation & Tec hnology US Department of Veterans Affairs VA-18-0298-I-000324 Page 622 of 2~1iof 1380 Document ID: 0.7.1705.527498-000009 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] VA-CIO CALL (9).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000325 Page 623 of 2~ 2~of 1380 To:RE:[EXTffi~~b] ~~i~~!,,(b"-')(G....;.. ) ____ From: Blackburn, Scott R. Mon 11/20/2017 10:33:01 PM Sent: Subject: RE: [EXTERNAL] VA -CI O CALL _.~iffi ~'{;l_~~02 ( Attachment 9 of 17) Dr. Moskowitz, Thank you so much for the note and for all the help/support. I would love to meet you in person. Do you have any plans to be in Washington anytime soon? l thou ght the call last week was extremely valuable. The experience and wisdom of the participants is such a great asset - we would be fools to not take full advantage of it . l do agree fully that there was a lot to cover in only two hours. I think the moderator was doing the best he could to get as much out of it as possible, while trying to be respectful of the time that so many important people were volunteerin g. If the 5 CIOswere willing to follow up, perhaps we schedule another session(s) on various deep dive topics? We would absolutely love that. Just by way of introduction - I jumped into the CIOrole less than 2 month s ago when our previous CIO(Rob Thomas) abruptly retired to deal with some personal issues. I am a disabled A1myVeteran (MITROTC).After getti ng out of service I went to business school and then to McKinsey where I made partner and spent 9+ years there leading large business transformations in industrial clients. Bob McDonald (the former P&G CEOand former Secretary) convinced me to join VAto lead the turnaround after the 2014 Phoenix scandal. From Feb-Sept, I served as Secretary Shulkin' s Deputy until a political appointee was put in place. Then jumped into the CIOrole to work with the team and make sure this gets done. We are still awaiting a permanent CIO. I would be happy to jump on the phone this week to if you would like. Thanks again for your suppor t! Scott Scott Blackburn Acting CIOand Executive in Charge, Office of Information & Technology US Department of Veterans Affairs Fro m: Bruce Moskowi t:zl~ (b~)(~6~ ) _______ Sent: Monday, November 20, 2017 6 :02 AM To: Blackburn, Scott R. S ubje c t: [EXTERNAL] VA-CIO CALL ~ @mac.com ] Dear Scott: I thou ght the V A-CIO call November 15 to help you wit h practica l indu stry expertise relat ing to your proposed Cerne r imp lementation generated some va luable conversa tion. Th e particip ants were some of th e most highl y experienced CI Os wi th de ep EMR ba ckgro und s, toge ther with ph ysician s who focus on medi cal error preve ntion and improvin g the EMR expe rience. I hope and expec t th at yo u fo und it of great va lue. Sin ce we have not spoken befo re, yo u m ay not be awa re that I am the person who perso nally recruited the Academic M edi cal Ce nt ers to pro vide the VA with advice, int end ed to help the VA creat e and implement a path to fix its care deli very issues, as well as advise on other area s where they can be of va lue to better veteran s' care. I have been a ce ntral point for the grou p and wa s the co llection point for the participants ' post-ca ll debrief. A lso , for reference pu rposes , eac h of the peopl e on yeste rday's ca Jl has perform ed flaw less impl ementat ions of state of the ar t EMR syste m s on be half of their respect ive hea lthca re de livery systems, some more than once. Since the ca ll wa s structured to focus th e di scussion on the few dir ec t questio ns set forth in yo ur agend a, and the moderator con troll ed the timin g of eac h qu estion very tightl y, th e breadth of th e disc uss ionVA-18-0298-I-000326 was somewha t lim ited. As a result , yo u on ly had the benefit of th e experts' advice in the areas that the moderator put on the table ... an d th e pa rticipant 's wa nt to mak e sure you have the benefit of their compl ete thou ght s and fee dba ck . Eve ryo ne fe lt good about Page 6Z4 of 2~1i of 1380 RE·1EXTERNAL ] VA-CIO CALL (9).ms g !Qr .Printed ltern: 302 ( Attach me[lt9 of Hl . . . the cl scuss10n on the agenda questio ns ana telt that tne scope ana unpl etnentation issues relating to DOD / VA interoperability were well in hand. Howe ver, some of the participant s' questions raised about other areas left them une asy about the readine ss of the system for implementation or the readiness of the Cemer RFP contract for execution . Based on some of the offshoot discussions, the participants felt that many non-DOD interoperabi lity solution s have not yet been fully addressed or solved, lead ing to incomplete system plannin g and contracting prot ections, greatly risking an unsuccessful implementation and large additiona l cost and time overruns. The interoperabili ty with commun ity provider partn ers did not seem to be defined comp letely. Some addition al area s that were identified by the VA and its contractor's participant s and moderator as incomplete in the call are: seamless sharing of Choice partner reco rds, duplicate procedure and medical error prevention, flagging mechanisms and implantable device identification, amon g others. Until the design of the system and all function al requirements are identifi ed and comp leted, the participants fear that these as yet undeveloped processes and solution s will re sult in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program. Lastly, at the beginning of yeste rday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process. However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discussion in a two hour phone call with a few questions. Also, as mentioned in the call at various times, the part icipants' did not have access to the RFP contract document , its scope and the contractua l provi sions and protections, a critical part they fee l of eva luating the completen ess of a success ful design and implementation. As such, the participants want to make sure that yeste rday's discussion is understood by everyo ne - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the modera tor, but not as a confirma tion of the project's completeness or readiness for contract execution or implementation, which they believe likely has shortfall s. In general, we liked what we heard, we are honored that you felt our adv ice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implem entation and whether the contract (from the limited discussion) has adequate safeguard s to proceed without risk to the cost and success of the effort. While this was the first time you have spoken to any of these part icipants on the topic of EMR, and maybe on any topic, the participant s wou ld be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomp lete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000327 2~of 1380 Page 625 of 2~ Document ID: 0.7.1705.527498-000012 Owner : Blackburn , Scott R. Filename: RE: lnteroperabilty listening sessions (11 ).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000328 Page 63 1 of 2~ 2~of 1380 To: RE: lnternERi,l~ t ~e1i-'?qr _efa~c,1~~~rf.~e~~vW~go~edItem:302 ( Attachment12 of 17) Cc : From: Sent: Subject : Byrne , Jim (OGC)[Jim .Byrne@va.gov] Black burn , Scott R. Thur 2/1/2018 11 :23:21 PM RE : lnteroperabi lty listening sessions (b)(5) Fro m : Fleck, Robert R. (OGC) Se nt : Wedne sday, Ja nuar y 3 1, 20 18 8 :28 AM To : Blackburn, Scott R. Subj ec t: RE: lnt eropera bilty listening sessio ns Scott , (b )(5) Bob Robert R. Fleck Chief Counsel , Procurement Law Group Office of the General Counsel Room 1050 810 Vermont Avenue, NW Washington , DC, 20420 Office 202-46 1-4954 ATTENT ION: This electronic transm ission may contain attorney work-product or information protected under the attorney-client privi lege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act , 5 USC §552 . Do not release this information without prior authorization from the sender . If this has inadvertently reached the wrong party, please delete this information immed iately and notify the sender. Any secur ity screen ing of this email by information officers or server adm inistrators is not intended to be consent to any party to review the content of the emai l or a waiver of the attorney-client privi lege and/or work product privilege. Fr om : Black bum, Sco tt R. Se n t: Tues day, Ja n uary 30, 20 18 2 :53 PM To: Fleck, Rob ert R. OGC Cc : (b)(6) VA-18-0298-I-000329 S ubj ec t: RE: Int eropera bilty liste ning ses sio ns Page 632 of 2~1i of 1380 RE: lntero~erabilly ,Jii,tenirJp sessions (11).msg for Printed Item: 302 ( Attachment 12 of 17) Can we ta IK at J.Jupm. From: Fleck, Robert R. (OGC) Sent: Tue sda y, January 30 , 20 18 2:33 PM To: Blackburn , Scott R. Cc: Byrne , Jim (OGC) Subject: RE: In terop erabilty lis tenin g sessio ns I can see you now. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel Room 1050 81 O Vermont Avenue, NW Washington, DC, 20420 Office 202-46 1-4954 ATTENTION: This electronic transm ission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party , please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the email or a waiver of the attorney-client privilege and/or work product privilege . From: Blackburn, Scott R. Sent: Tue sday , January 30 , 20 18 2: 32 PM To: Fleck , Robert R. (OGC) Cc: Byrne , Jim (OGC) Subject: RE: Interoperabi lty listening sessions (b)(5) From: Fleck, Robert R. (OGC) Sent: Tue sday , Ja nu ary 30 , 20 18 10:27 AM To: Blackburn, Scott R. Cc: Byrne , Jim (OGC) Subject: RE: lnteroperabilty listening sessions Scott, (b)(5) If you have any questions, please let me know. Bob Robert R. Fleck Chief Counsel, Procurement Law Group Office of the General Counsel VA-18-0298-I-000330 Page 633 of 2~\iof 1380 RSbr'At e{~ 5'Qbilty listening sessions (11).msg for Printed Item: 302 ( Attachment 12 of 17) 81 O Vermont Avenue, NW Washington, DC, 20420 Office 202-461-4954 ATTENTION: This electronic transmission may contain attorney work-product or information protected under the attorney-client privilege. Portions of this transmission may contain information also protected from disclosure under the Freedom of Information Act, 5 USC §552. Do not release this information without prior authorization from the sender. If this has inadvertently reached the wrong party, please delete this information immediately and notify the sender. Any security screening of this email by information officers or server administrators is not intended to be consent to any party to review the content of the emai l or a waiver of the attorney-client privilege and/or work product privilege. From: Blackburn , Sco tt R. Sent: Monday, Janu ary 29, 2018 11:04 AM To: l(b)(6) @who .eop.gov Cc: r1ecK , Kuoek R. (OGC); Byrne , Jim (OGC); l(b)(6) Subject: Interoperab ilty liste ning sessions ~-------~ Jane, It was a plea sure meetin g you toda y. I am cc'ing Jim Byrne and Bob Fleck. Jim/Bob - (b)(5) (b)(5) Scott Scott Blackburn Acting CJO& Executive-in -Charge, Office of Information & Technolog y Depart ment of Ve te ran s Affairs VA-18-0298-I-000331 Page 634 of 2~\~ of 1380 Document ID: 0.7.1705.527498-000013 Owner : Blackburn , Scott R. Filename: RE: SecVA (12).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000332 Page 635 of 2~j~ of 1380 To: RE: SecV~1~<mfh~~~'b1\ef¾:{grc'dlr~~d~J~!r.~; l(b)(6) g>va.gov] Cc: Colli, Jacquel ine[Jacqueline .Col li@va.go~ ;kb)(6) Rinchack, Diane[Diane .Rinchack@va.gov]; Llamas, Jose[jose .llamas@va .gov]; Turner, Tanya T.[Tanya.Turner3@va.gov] From: l(b)(6) Sent: Fri 3/9/2018 9:10:18 PM Subject: RE: SecVA I I Scott, this breakfast is off. Mr. Perlmutter can no longer do . No need to trave l, Scott. Sorry about that . Thank you. From: Blackburn , Scott R. Sent: Friday, March 09 , 2018 4:09 PM Tol{b)(6) I Cc: Colli , Jacqueline l.._ (b_,_ )(.... 6.,_) __________ RE: SecVA _.IRinchack, Diane; Llamas, Jose; Turn er , Tanya T. Subject: Awesome! Thanks so much. From:~(b ~)~(6~ ) ----~ Sent: Friday, March 09, 2018 2:50 PM To: Blackbum, Scott ,... R...__ __________ Cc: Colli, Jacqueline J(b)(G) Subject: RE: SecVA ~ IRinc hack, Diane; Llama s, Jose; Turner, Tanya T. Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackbum, Scott R. Sent: Friday, March 09 , 2018 2:19 PM To: l(b)(6) I Cc: Colli, Jacqueline; l(b)(6) RE: SecVA ~-----------~ Subject: I'll be there. I'll plan to mimic his sched ul e. Sent with Good (w ww.good .com) From:l~(b_)(_6)___ ~ Sent: Friday, March 09 , 2018 2:18:28 PM To: Blackburn, Scott ,...E~-------------. Cc: Colli, Jacqueline; l(b)(6) SecVA ~-----------~ Subject: Scott - just a heads up that boss wants you to travel with him to Mar-A-Largoon Tuesday . He will be meeti ng 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-I-000333 Page 636 of 2~\~ of 1380 Document ID: 0.7.1705.527498-000014 Owner : Blackburn , Scott R. Filename: RE: Update (13).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000334 Page 637 of 2~j~ of 1380 To: RE: Upd~M~m~J8~'na~JdAfl'ffirl8g~i~'ti)chment 14 of 17) From: Blackburn, Scott R. Sent: Tue 3/27/2018 12:19:27 PM Subject: RE: Update Hmm. Have you spoken to the Secre tary direc tly yet? I wrote him about Marc Sherm an's email but he didn ' t respond. Not sure where his hea d is at. I don ' t understand why ogc wo uld meet him without you. It kill s me how we don ' t trust each other and try to work point to point through the Secretary. Sent with Good (www.good.com) From: Windom , John H. Sent: Tuesday, March 27, 2018 6 :34: 17 AM To: Blackbum , Scott R. Subject: Update Sir There was a meetin g between Shulkin and the attorneys (Byrne and Fl eck) last week that I was not invited to . This is the language propo sed for inclu sion in the con tract following that mee tin g. Does the inclu sion of thi s language clo se the deal? Befo re nego tiatin g with Ce rner, I need to under stand weat her it clo ses the dea l. I discuss with the TAC thi s mornin g . Ju st received yeste rday eve . Thank you. John John , Ref erence is made to the note I sent you last Wednesday whe reby I mentioned that OGC (Mr. Byrne) wanted to re view our RFP. Mik e Kray c inov ich recently shared th e following OGC reque sted PWS change (italicized) presumab ly as a res ult of that review : Plea se consider this recommend ed change to PWS Sect ion 1.0 betwee n what is currently the first paragrap h and the seco nd para graph -The proje ct has been awarde d via the public interest exce ption in FAR 6.302-7. The goa l of this accelerated award is to deliver a mode rnized sys tem in the best interests of Veterans, their hea lthca re, and the provid ers that care for them both inside the VA and in co mmer cial care settings . Thi s awa rd contemplat es the provi sion of serv ices by Cerner Corpora tion, and accord ingly these document s referen ce Cerner Corporation and its softw are and ser vices. However, the Gov ernm ent may determin e that in so me cases a diff erent source of softw are and/or servi ces will best support the public's int erest in areas such as qua lity of care, patient engagement, operationa l efficiency, or interop erab ility to fulfill the goa ls of Electronic Health Recor d Mo derni zation , the Veterans ' Choi ce program, or other reason as the Governme nt may dec ide. The Go vernme nt ma y requ ire perfor mance of part of this awa rd by an alternativ e so urce in any such case , in acco rdance with procureme nt laws and regulation s. Th is may includ e, for exa mpl e, delivery of software or services by another contracto r w ithin the Gove rnment 's comp etitiv e range for the D epartment of Defense's DHMSM as provide d in the Government's February 19, 2015 notic e. Sent with Good (www.goo d.com) VA-18-0298-I-000335 Page 638 of 2~1~ of 1380 Document ID: 0.7.1705.527498-000015 Owner : Blackburn , Scott R. Filename: RE: VACIO advisory support for Gerner contract (14).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000336 Page 639 of 2~j~ of 1380 To: RE: VA Cl§l e1-~ {~WIY!,u ..&_~ ~~ci1,C3.r~tfJ9~d~Wfi'g~lrS~gf8vf rintedItem:302 ( Attachment 15 of 17) From: Sent: Subject: Blackburn, Scott R. Fri 11/3/2017 10:23:29 PM RE: VACIO advisory support for Gerner contract Thanks Avi. I managed to find the other 4. I will shoot them all an email over the weekend. I'll cc you guys too in case you want to be included. Thanks for all the support. Have a great weekend, Scott From: Berkowitz, Avrahm J. EOP/WHq (b)(G) ~wh o.eop.gov] Sent: Wedne sda y, November 01, 2017 9: 33 AM To: Blackburn, Scott R. Subject: [EXTERNAL]RE: VACIO advi sory support for Cerner contract Richard D. DanielsL.l (b_)(_6_) ____ _,@_kP~·o~rg Here is the first he can help likely with the others - let me know if you need help tracking them down - I don ' t have them at the moment From: Blackb urn , Scott R.fm ailto:Scott.Blackburn@va.gov] Sent: Tuesday, Octob er 31, 2017 4:3 1 PM To: Berkowi tz, Avrahm J. E0P / WHtj (b)(6)l@who.eo p.go v> Subject: FW: VACIO advisory support for Cem er contract HiAvi, Happy Halloween! I just want to follow up on this exchange with Jared. Can you help connect us with the 5 CIOs so we can bounce our EHRplan off of them before we go final? Thanks again for all the support! Scott From: Kushner , Jared C. EOPIWHOl(b)(6) @who.eop.gov] Sent: Friday, October 27 , 2017 5:36 AM To: Blackburn, Scott R. Cc: Liddell, Christophe r P. EOP/WHO; Windom, John H.; DJS; Berkowi tz, Avrahm J . EOP/WHO; Dumbauld, Cassi dy M. EOP/WHO Subject: [EXTERNAL] Re: VA CIO ad visory support for Cerner contract (b)(5) Avi will conn ec t you and sched ule next meeting Sen t from my iPhone On Oct 27 , 2017 , at 1:56 AM, Blackburn, Scott R. wro te : Jared / Chris (b)(5) VA-18-0298-I-000337 t-'age b4 J of 2~\~ of 1380 RE: VAC IO advisory support for Cer1wr contract U 4) .JTISQ <~ tracted> for. Printed ltwuf· 302 ( Attachmetit l.5 of 17) co urse we wou10 Jove tor the two or you to Jom as well I you are ava11aule. (b)(5) Scott This is Scott Blackbw-n, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours. I will be accompanied by the Program Executive Officer for VAElectronic Health Record Modernization (PEO EHRM),John Windom, and his key staff members including his Chief Medical Officer (CMO), ChiefTechno logy Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterpa rts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFP with particular emphasis on notable "fail points" EHRdeployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc. to name only a few, but look forward to your thoughts on these and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000338 Page 641 of 2~\i of 1380 Document ID: 0.7.1705.527498-000016 Owner : Blackburn , Scott R. Filename: RE: VA MEETING (15).msg Last Modified: Sun Apr 08 16:16:11 CDT 2018 VA-18-0298-I-000339 Page 642 of 2~j~ of 1380 To: RE: VA ~Js~ for Printed Item: 302 ( Attachment 16 of 17) From: Blackburn, Scott R. Tue 11/ 14/20177:15:28PM Subject: RE: VA MEETING Sent: thanks From: DJS Sent: Tue sday, November 14, 20 17 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday, November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For th e 5 CIOs who ask, I will tell them th at Bruce is an advisor and exte nsion of the WH/VA team. Is th a t ok to say? From: DJS Sent: Tue sday , November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VAMEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with th e 5 CIOs is Wednesday 3-Spm. On our p re -calls, 2 of th e CIOs have asked about Bruce and wha t his involvement is. I have neve r had any contac t with Bruce, but it seems like a sensi tive relationship. Any advice on ho w to han dle? We invited Jared/Chris from WH as a court esy. I don't think either plan to join, but th ey must have invited Bruce who is now asking a few others to join (see below). Can discuss live lat e r before or after hearin g prep. Scott From: Schnitzer , Jay J l(b)(6) lzvmitre.org) Sent: Tue sday, November 14, 20 17 12:47 PM To: Blackburn, Scott R. Cc: Wynn , Jacki e VA-18-0298-I-000340 Page 643 of 2~\i of 1380 Hi Scott, Pl ease see the ema il trail below. Ju st wan t you aware in case we have people j oining the call wi thout your know ledge or approval. Thanks, Best , Jay Jay J. Sc hnit ze r, M .D. , Ph.D. MITRE Fro m : Noga, Jame s! Date: Tuesday, Nov 14, 20 17, 11:43 AM @mgh.harvard.edu> To : Karso n, An drew Scott ,M .D . l(b)(6) l@mitre.org> Cc: Schnit zer, Jay J!(b)(6) Subject: RE: VA MEET ING But do the people hosting th e call know you are going to be on the call? I am copying Jay as he is helping coordi nat e the call. Jim From: Karson, Andrew Scott ,M.D. Sent: Tuesday, November 14, 2017 11:31 AM To: Noga , James l(b)(6) l@PARTNERS.ORG> Subject: RE: VAMEETING Dear Jim, Tha nks for the not e. I think that you a nd I ma y have a little mis-under stan ding. I agree th at you can of course handle the call, but Gregg and Bruce Moskovitz invited me to th e call tomorrow so th at they can have a hand s-on clinicians perspective. Bruce and I spoke very briefly (be tween his pa tien ts) a little while ago and Bruce sen t me the below informa tion. I am hoping to touch base with you before th e call if th a t is possible for you. I am tied up in pre se ntation s/ meetings the rest of th e da y, but co uld speak this eve ning (6pm?) or tomorrow if tha t is okay with you. (And if needed I will break out of othe r meetin gs today) . Many than ks, Andy From: Noga, James Sent: Tuesday, November 14, 20 17 11: 16 AM To: Karson, Andrew Scott ,M.D. l(b)(6) ~mgh.h arva rd.edu> Subject: RE: VAMEETING I had a call with them toda y in prep for tomorrow 's call. I appr eciate the offer but I don 't think it is my place to invite you. It needs to come from th e VA. From: Karson, Andrew Scott,M .D. Sent: Tuesday, Novem ber 14, 20 17 11: 11 AM To: Noga , Jame~(b)(6) @PARTNERS.ORO> Subject: FW: VAMEETING Dear Jim, Given some conflicts that Gregg has being a senior advisor for the VA,Gregg has asked me to join the 3pm VAcall tomorrow to be availab le for the clinician pe rspective. Wou ld you be up for a 15 minute check -in call with me at some point tomorrow before the VAcall? If so, then I'll reach out to Susan Briggs to get us a time. Many th anks , Andy From : Karson, Andrew Scott ,M.D. Se nt: Tuesday , November 14, 20 17 11:06 AM To: 'Bruce Moskowit zj(b)(6) !@mac.com> Subject: RE: VAMEETING VA-18-0298-I-000341 Page 644 of 2~\~ of 1380 RE: VA MEETING (15).msg for Printed Item: 302 ( Attachment 16 of 17) Dear Bruce, Ma ny th anks for the note . I'll review the below a little later today and I'll be back in to uch. Ma ny th anks and best, Andy From: Bruce Moskowitz l(b)(6) l@mac.com] Sent: Tuesday, Novem be r 14, 20 17 10:45 AM To: Karson, Andrew Scott,M.D. l(b)(6) l@mgh.harvard.edu> Subject: VA MEETING The call will take place this Wednesday, November 15th between 3:00 PM and 5:00 PM Dial In Numberl..... (b_)(_6)____ _, Passcode: ..... l(b_)(_G l_ __, Thank you for your time and involvement. Some backgro und information. These are my concerns as a clinician. Cerner does not have the ability to provide the following in the Choice Program: Track ing duplicate testing Track ing over utilization by provi ders Tracking duplicate prescriptions and medication errors. Tracking tests that were ordered , completed and resu lts go to all physician s involved in the Veterans care Patient notification of critically abnormal results with follow up resolution Arranging appointment follow up between the VA and Private sector Emergency room visits in the private sector ability to access records immediately and VA physicia ns notified of emergency care and followup Cemer has no registry to tract what Cardiac and orthopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Pro vider to the VA patient record with flagging new information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radio logist needs to know if a lung nodule is new or was there previously and the same size. Cardiolo gists need to access cathe terization films in high definition Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in real time . Sent from my iPad Bruce Moskowitz M.D. The information in this e-mail is intended only for the person to whom it is VA-18-0298-I-000342 Page 645 of 2~\~ of 1380 RE: VA MEE.TING (j5) ..msg fo~rr inted Item: 302 ( Attachment 16 of 17)th . addressed. lt you be11eve tms e-ma 1 was sent to you m error and e e-ma 11 contains patient information, please contact the Partners Comp liance HelpLine at http://www.partners.org /compliance line . If the e-ma il was sent to you in en-or but does not contain patient inform ation, plea se contact the sender and properly dispose of the e-mail. VA-18-0298-I-000343 4~of 1380 Page 646 of 2~ Document ID: 0.7.1705.526931-000002 Owner : Blackburn , Scott R. Filename: [EXTERNAL] Fwd: Contact review (2).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000344 4~of 1380 Page 686 of 2~ To:[EXTER~hl_l~~.n!38B"ftv~,s86W!l:lf~ellrJurRtdRtl~~ Item:320 ( Attac hment2 of 15) From: David Shulkin Sun 3/ 11/2018 4:31 :54 PM Subject: [EXTERN AL] Fwd: Contact review Sent: Scott lets discuss tommorow Sent from my iPhone Begin forwarded message: From: David Shulkin !(b)(6) @gmai l.com> Date: March 11, 20 18 at 12:31:22 PM E DT To: Bruce Mo skowitzl.!.. (b..:.,; )(:....6 ):....__---,-___ ~ =m=a=c=.c=o=m> Cc : IP (b)(6) mail.com, Ll (b_)(_6)__ Subject: Re: Contact review __... µv ___ gm_a_i l._c_om_ Gr eat 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 Mo skowitz l(b)(G) @mac.com> wrote: Th ese are the individua ls to review the con trac t; Stephanie Reel CIO- hopkin s Stan Huff CIO- intermi untain Jon athan ManisCIO- suttrr Andrew Karson MD. - par tners Leslie Cooper M.D. Clif ford Ko M.D.- ame rican college surgeon s Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000345 Page 687 of 2~\~ of 1380 Document ID: 0.7.1705.526850-000007 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] Re: VA EHR (7).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000346 4~of 1380 Page 788 of 2~ 1 To:RE: [EXTB~~.V~cfiltrifltt'<~8tf~l~8~~?R~OW~~dl>f,s38~M1M ~ltW&Jacg[ffiomas.Bowman@va .gov] Cc: Zenooz, Ashwini[Ashwini.Zenooz@va.gov] ; Short , John (VACO)[Joh n.Short@va.gov ] From: Windom, John H. Sent: Fri 3/23/2018 5:54:36 PM Subject : RE: [EXTERNAL] Re: VA EHR Mr. Blackbum, I went ba ck and re ad Mr. Sherman 's emai l and review ed my notes. I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sand box/ tes t platform in advance of contract award. Vr John John H. Windom, Senior Executive Service (SES) Program Executive for Electronic Health Record Moderni za tion (PEO EHRM) Special Advisor to the Under Secretary for Health 811 Vermont Avenue NW (5 th Floor Suite 5080) Washin gton , DC 20420 John. Windom@va .gov Office: (202) 461-5820 Mobile: ...,b......_6...,_ ___ --,..__ __ _, Executive Assistant: Ms. (b)(S) - Appointments and Scheduling l(b)(6) @va. gov Office: 202-382-3792 From: Windom , John H. Sent: Friday, March 23, 2018 1:47 PM To: Blackbu rn , Scott R. ; Bowm an, Thoma s Cc: Zenooz, Ashwini; Short, John (VACO) RE: [EXTERNAL] Re: VA EHR Subject: Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians, various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type . We have provisions in the EHR contract to insert technology as we, the VA, as well as to incorporate evolving technology and standards. The DVPacquisition is our bridge to the use of APis (gateways), FHIR,etc . We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the rece nt phone call to sto p Marc Sherman, et. Al's parade of nation al interoperability objectives as not feasible at this juncture "anywhere," but included as part of our overall interoperability strategy that includes the DVPacquisition/strategy. We are committed to establishing the interoperabilit y test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition , I belie ve Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below. Mr. Sherman do es not understand the culture of VAor the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHRModernization effort. He appears to be more of a "big bang " theor y guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulation s/policies (e.g. cybersecurity, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology , innovation opportunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities (IOC)process and the judicious issuan ce of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to reco gnize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas, not mor e words in the contract. VA-18-0298-I-000347 V/r , John Page 789 of 2~\~ of 1380 Re; VA EHR /7J..msri fodrP,ri,ntedlte.rn:336 / Attachment 7 of 15) l;U;:JEKT.EBI\IALl ID IV PWl'i 5.5.l. worktlow Deve 1opment an ~ormanzat1oh: j) The Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled externa l data . By IOCentry, the Contractor shall support incorporation of the following external community data domain s, including but not limited to these domains and sub-domains: • Problem s • Allergies • Home Medications • Procedure s - including associated reports and with appropriately filtered CPTcodes • Immunizations • Discharge Summaries • Progress Notes • Consult Notes • History & Physicals • Operative Notes • Radiology and Diagnostic Report s (Into "Documentation" component) By IOCexit, the Contractor shall support incorporation of the following externa l community data domains , including but not limited to th ese domains and sub-domains: • Results oLabs - General - Patho logy and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report " component) • Images IDIQPWS Sectio n 5.10.4: Seamless Interoperability/ Joint Industry Outrea ch includes significant detail on the topic. The interoperability section is copied below this table for reference. IDIQPWS section 5.5.4 Data Exchange - Application Program Interface (API) Gateway also includes detail on the creation of strategic open APis. VA NF-177: Interoperability - Data Standards: The system shall support the use of the health data standard s identified in the VA DoD Health Information Technical Standards Profile and by the VADoD Interagency ClinicalInformatic s board, including following common data standard s: National Information Exchange Model NTEM;Health Level 7 HL7;Logical Observa tion Identifier s, Names and Codes LOINC;Systematized Nomenclature of Medicine SNOMED;RxNorm, MedRT, ICD,CPT,HCPCS,Veteran Information Model VIM;and Healthcare Information Technology Standards Panel HITSPas well as VA/DOD/IPOextensions to the se standards. VA-NF-T23:Informatics - Care Integration: VAmust be able to sea mlessly integrate with HIEand external-to-EHR shared services to provide for a seamless experience and to more effectively integrate in community care efforts, as well as with other parts of VA (e.g., identity mana geme nt). This includes but is not limited to the EHRprodu ct ability to support externa l shar ed services (SOA services, such as identity management, care plan service, scheduling, etc.) accessed via standards -based APis. (Process Continuity, Evolution , Extension) KSR5 [NOW+) VA NF-Zll: Health Information Exchange: The system shall support VAelectronic exchange of health records via other interoperable networks (e.g. CareQuality, Common Well Health Alliance, DirectTrust, National Association for Trusted Exchan ge) by supporting their specification s, security and content specifications 5.10.4 Seam less Interoperability/ Joint Industry Outreach The Contractor is requir ed to collaborate with VAaffiliates, communit y partners, EHRpro viders, healthcar e pro viders, and vendor s to pro vider market. Seamless care will require the crea tion of an inte grated inpatient and outpatient solution with software compo nen1 and deployed with a design architecture that allows for access to and sharing of common data and an enabling security framework th VA-18-0298-I-000348 and business operations. Seamless care is the experience patient s and pro vider s have moving from task to ta sk and encounter to enc high-quality decisions form easily and complete care plans execute smoothly. Information system s support the seamless-care experie information , and managing tasks. Currently, industry lacks spec ific and uniform inte roperability standard s t~t)Sfflffllm s care be -348 of 1380 V' RE: IEXTEB.NAU Re: VA EHR /7) .msri for Printed l!~ m· 336 / Att"-chment 7 of 15) . . . . . e tc., to the ex rent such exte nsions are cons isten t w1tn the rhooel anct be st practice s of the con trolling national standard. This include knowledge with clinical partners. This foster s rapid adoption from industry be st prac tices, e .g., clinical profe ssional societie s. 5.10.4 .1 Data Desi gn and Information Sharing In support of th e interop erability objective s und er this Section, agree d upon Contractor propri e tar y information/data mod e l e xte nsio provided to both international and national standard s de signating organization s as de scribe d and se t fort h in an appli cabl e Task Orde right s into an y underlying proprietary terminolog y/code system s for the purpo se of enhancing nationa l standard s to address an y gap i shall also make the interoperability capab ilities and product enha ncement s developed under this contract availab le to non -VACerne r 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VAanticipates de veloping a Digital Healt h Platform/Di gital Veteran s Platform (DVP) to consoli date critica l VAEHRand non-EHR opera EHRMto interopera te with DVP, or future state VAplatform, including the DVPAPI gateway or any other method de signate d by VA. John H. Windom, Senior Executive Service (SES) Progra m Executive for Electronic Hea lth Record Mode rnization (PEO EHRM) Special Advisor to the Under Secre tary for Health 81 1 Vermont Avenue NW (5 th Floor Suite 5080) Washington, DC 20420 John.Windom@va .gov Office: (202) 46 1-5820 (~6)~-----Ji~;-------, Mob ile: ~(b:.'...:) Executive Assistan t: Ms b) (S) - Appointme nts and Scheduling l(b) (6 ) ~ va.go v Office: 202-382-3792 From: Blackburn, Scott R. Sent: Friday, March 23 , 2018 12: 15 PM To: Windom , John H.; Bowman, Thoma s Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary/Deputy' s office before end of day to get a sense of where he is with respect to this. Sent with Good (www .good.com) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackbum, Scott R. Cc: Bruce Moskowit z; DJS S ubj ec t: [EXTERNAL] Re: VA EHR Scott , VA-18-0298-I-000350 Than ks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my tho ughts for your consideration when requested. Page 792 of 2~1i of 1380 RE: fEXTERNAl.,l Re: VA EHR 1. 7).rn_sg<~){lracted.- IQI P~nted Item: 336 ( Atta~hm!;)nt 7 of 15) , . . I reaa carerur1yyour ema1 aooui me er,orcs to worK out tne no1es ra1sea by the experts. You are on the way to k1ck1ngoff an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard; and I know everyone has the goal to bui ld the best next generation system for the veterans' healthcare . However , there were several major issues raised in the calls this week with the technica l and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts . These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer, but I respectful ly don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted ; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has var ious enhancements to today's standard system functiona lity. At a minimum, I heard those experts express the ir opinions that the contract dangerously lacks definitions , standards and a clear expression of this required , defined enhanced (non-standard ) functiona lity (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambigu ity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity . Including contractua l clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functional ity des ired and have a better understand ing of what is expected of them. Clarity in the contract is a healthy ingred ient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous. You say that "risk cannot be 100 % driven out of any transformation of this magnitude ," a concept to which I subscribe . However , when you subst itute this concept for clear, written and defined functiona lity, especially for a design that is expected to be unique in many respects , you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions , but the experts are so united on this point; and together with my historical observa tions of fai lures in nearly identical situations I just see warning flares going off. Scott, I want to see th is project get started , and qu ickly, as much as anyone , but wit h the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time . Jus t my opinion and food for thought as you make your decisions. Marc On Wed , Mar 21 , 201 8 at 10:19 PM , Bl ackburn , Scott R. wrot e: Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VAOpen APIPledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at Intennountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIRAPis for VAin support of this contract. This will also benefi t Intermountain as Stan was telling us they've only had I 0-15 for their entire company to date. If VA/DoD/Intermountain work together we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000351 Per Stephanie 's suggestion, we are going to start moving forward ASAPon formalizing an Advisc,rM~~ iof%~~ that -35 'I' of 1380 RE: [EXTERNAL ] Re· VA EHR /7).msg for.Printed llem:..336 / Allach ment 7 of.j.5l . . . . we can get these 1ns1gmson an ongoing basis. t-b~W~fWyepb~ghW111yantiquated definitions. Bruce/Marc, thank you for everything. As I mentioned to Bruce recently, you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott From: Marc Sherma~(b )(6) ~ gma il.co m] Sent: Wednesda y, March 21, 2018 9:31 AM To: Blackbum, Scott R. Cc : DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled. I will outline my nighttime thoughts below in case you find them useful. 1. I thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability, " especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the ri sk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling. Unfortunately, if this "gap " in definition is not di scovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design, happi er user co mmunit y, less overall cost, better healt hcare delivery, etc . The n , wit h the sta nd ard fully defined and set in the origi nal PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing th e user s to provide input sooner and better, elimi nating costly de sign mistakes from the beginning. The user comm unit y can tell you today what is needed to accomplish this "next generation " system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why wou ld you not want to tell the contractor the specific s of that now, in fairnes s to them, the VA, the patient s and healthcare, so they can proceed with that standard from day one or express any concern s they may have now instead of in the future after co stly de sign has occurred? Why wou ld you not want to be specific in the contract to prevent ambig uit y? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cit ed Section 5 (I believe he said sect ion 5 .1. 1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectivene ss of the existing contract language to others, but commented that the CIO of MAYOread the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2. I was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the user s and chart them out. Then identify which of those issues would be issue s if they existed in the VA implementation and include them in the contract as definitional requirement s . You have the benefit of knowing the failures in the very system upon which you are modeling your system ... and you have an added advantage and opportunity to contractually prevent similar mistakes. 3. I have ot her thought s as well that we should discu ss, but these are the ones that I felt more pressing to highlight since I will be un avai lable today. Best VA-18-0298-I-000353 Marc Page 795 of 2~1~ of 1380 RE: [EXTERNAL ] Re: VA EHR (7).msg for Printed Ite m: 336 ( Attachment 7 of 15) On Wed, Mar 2 1, 20 18 at 8:24 AM , Blackbum, Scott R. wro te: No problem Marc. Thanks for all your help. Very helpful call last night. From: Marc Sherman!/b)/6) @g mail.com ] Sent: Wednesday, March 21, 20 18 12:12 AM To: Blackbum, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to joi n the call tomorrow as I have a previo us commitment that I cann ot move . I will catch up with yo u or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote: Bruce/Marc - thanks for introdu cing us to all the expe rts we talked to tonight. It was extremely valuable. We have Stan Huff from Intermountain tomorrow at 10am. I assume you have the calendar invite , bu t just in case it is 1- l(b)(6) I We have been unable to sched ule anything with Dr. Ko (very busy calen dar). We will trying. Scott Scott Blackb um Exec utive in Charge, Office of Inform ation & Tec hnology US Department of Veteran s Affairs VA-18-0298-I-000354 Page 796 of 2~1iof 1380 Document ID: 0.7.1705.526850-000008 Owner : Blackburn , Scott R. Filename: RE: [EXTERNAL] VA-CIO CALL (8).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000355 Page 797 of 2~ 5~of 1380 From: Sent: Subject: Blackburn, Scott R. Mon 11/20/2017 10:33:01 PM RE: [EXTERNAL] VA-CIO CALL Dr. Moskowitz, Thank you so much for the note and for all the help/support. I would love to meet you in person. Do you have any plans to be in Washington anytime soon? l thought the call last week was extremely valuable. The experience and wisdom of the participants is such a great asset - we would be fools to not take full advantage of it. l do agree fully that there was a lot to cover in only two hours. I think the moderator was doing the best he could to get as much out of it as possible, while trying to be respectful of the time that so many important people were volunteering. If the 5 CIOswere willing to follow up, perhaps we schedule another session(s) on various deep dive topics? We would abso lutely love that. Just by way of introdu ction - I jumped into the CI0 role less than 2 months ago when ou r previous CI0 (Rob Thomas) ab rupt ly retired to deal with some persona l issues. I am a disabled A1myVeteran (MITROTC).After getting out of service I went to business school and then to McKinsey where I made partner and spent 9+ years there leading large business transformations in indu strial clients. Bob McDonald (the forme r P&G CEOand forme r Secretary) convinced me to join VAto lead the turnaround after the 20 14 Phoenix scandal. From Feb-Sept, I served as Secretary Shulkin' s Deputy un til a political appointee was put in place. Then jumped into the CIOrole to work with the team and make sure this gets done. We are still awaiting a permanent CIO. I would be happy to jump on the phone this week to if you would like. Thanks again for your support! Scott Scott Blackburn Acting CIOand Executive in Charge, Office of Information & Technology US Department of Veterans Affairs From: Bruce Moskowitzl..., (b..., )(,,...S-,. ) ......,.,.,...,.-,.....--.-r-r---~~ mac.com ] Sent: Monday, November 20, 201 / 6: 02 AM To: Blackburn, Scott R. Subject: [EXTERNAL]VA-CIO CALL D ear Sco tt: I thought the V A-CIO call November 15 to help you wit h practical indu stry expe rtise relat ing to your propo sed Cerne r imp lementation generated some valuab le conversation. Th e participant s were some of the mo st highly experienced CI Os with deep EM R backgrounds, together with phy sic ian s who foc us on medical error prevention and improving the EMR expe rience. I hope and expect that yo u fo und it of great va lue. Since we have not spo ken before, yo u may not be aware that I am the person who personally recruit ed the Acade mic Medical Ce nt ers to provide the VA with advice, int ended to help the VA create and implement a path to fix its care delivery issues, as well as advise on other areas where they can be of value to better veterans' care. I have been a central point for the group and was the co llection point for the participant s' po st-call debri ef. A lso, for referen ce p urp oses, eac h of the people on yesterday's ca Jl ha s performed flawles s impl ementat ions of sta te of the art EMR syste m s on be half of their respect ive hea lthcare de livery syste ms, some more than once. Since the ca ll was struct ured to focus th e di scuss ion on the few direct ques tions set forth in your age nd a, and the moderator contro lled the timing of eac h que stion very tightly, the breadth of th e di scuss ionVA-18-0298-I-000356 was somewhat limited. As a result, you on ly had the benefit of the experts' advice in the areas that th e moderator put on the table ... and the participant' s wa nt to make sure you have the ben efit of their comp lete thoughts and fee db ack . Ev eryone fe lt ~ood about Page 798 of 2~1i of 1380 RE·1EXTERNAL ] VA-CIO CALL (8).ms g !Qr .Printed ltern: 336 ( Attach me[lt8 of 15) . . . the cl scuss10n on the agenda questio ns ana telt that tne scope ana unpl etnentation issues relating to DOD / VA interoperability were well in hand. Howe ver, some of the participant s' questions raised about other areas left them une asy about the readine ss of the system for implementation or the readiness of the Cemer RFP contract for execution . Based on some of the offshoot discussions, the participant s felt that many non-DOD interoperabi lity solution s have not yet been fully addressed or solved, lead ing to incomplete system plannin g and contracting protections, greatly risking an unsuccessful implementation and large additiona l cost and time overruns. The interoperabili ty with commun ity provider partn ers did not seem to be defined comp letely. Some addition al area s that were identified by the VA and its contractor's participant s and moderator as incomplete in the call are: seamless sharing of Choice partner reco rds, duplicate procedure and medical error prevention, flagg ing mechanisms and implantable device identification, amon g others. Until the design of the system and all function al requirements are identifi ed and comp leted, the participants fear that these as yet undeveloped processes and solution s will re sult in a significant increase in the cost of the implementation and operation of the Choice program and impact quality care delivery to our veterans who choose to take advantage of the Choice program. Lastly, at the beginning of yeste rday's call your moderator identified the comfort that Congress expressed at recent hearings from the participation of the CIOs in the process. However, yesterday's relatively short discussion on a massive topic was limited and not set up to have a platform for full discussion in a two hour phone call with a few questions. Also, as mentioned in the call at various times, the part icipants' did not have access to the RFP contract document , its scope and the contractua l provi sions and protections, a critical part they fee l of eva luating the completen ess of a success ful design and implementation. As such, the participants want to make sure that yeste rday's discussion is understood by everyo ne - the VA and Congress alike - to be a limited dialogue to provide their valuable experiences on the topics put on the table by the modera tor, but not as a confirma tion of the project's completeness or readiness for contract execution or implementation, which they believe likely has shortfall s. In general, we liked what we heard, we are honored that you felt our adv ice would be of value, but have had discussion about a very limited part of the project and have questions about the system design, whether it is ready for implem entation and whether the contract (from the limited discussion) has adequate safeguard s to proceed without risk to the cost and success of the effort. While this was the first time you have spoken to any of these part icipants on the topic of EMR, and maybe on any topic, the participant s wou ld be pleased to provide further feedback and advice should you desire on the remaining issues that are still incomp lete and to help you work toward a successful RFP contract, design and implementation. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000357 5~of 1380 Page 799 of 2~ Document ID: 0.7.1705.526850-000011 Owner : Blackburn , Scott R. Filename: RE: SecVA (10).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000358 Page 805 of 2~ 5~of 1380 1 1 To: RE: SecV~1~8ltmfh~~~'b1\ef¾:{grc'dlr~~d~JM~!r.~Wb )i6)' ta>va.gov) Cc: Colli, Jacquel ine[Jacqueline .Col li@va.go~ ; @)(6 ) IRinchack, Diane[Diape Rjnchack@l(a.gov]; Llamas, Jose[jose .llamas@va .gov]; Turner, Tanya T.[Tanya.Turner3@va.gov] C) From: Sent: Subject: ____I ,__ J(b)(6) _. Fri 3/9/2018 9:10:18 PM RE: SecVA Scott, this breakfast is off. Mr. Per lmutt er can no longer do . No need to trave l, Scott. Sorry about that . Thank you. Awesome! Than ks so much. From: """l (b-'-)('""'6 )____ _, Sent: Friday, March 09, 2018 2:50 PM To: Blackbum, Scott R. Cc: Colli, Jacqueline; .-l (b-)(_6_ ) Subject: -----------.I Rinc hack, Diane; Llama s, Jose; Turner, Tanya T. RE: SecVA Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you ! From: Blackbum, Scott R. Sent: Frida , March 09 , 2018 2:19 PM To (b)(6) Cc: Colli, Jacqueline; ~(b_)_(6_) __________ Subject: ~ RE: SecVA I'll be there. I'll plan to mimic his sched ul e. Sent with Good (w ww.good .com) From:"'"i(b;._._)("""6.,_) ____ _. Sent: Friday, March 09 , 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline; l,(b-)(_6_ ) ------------, Subject: SecVA Scott - just a heads up that boss wants you to travel with him to Mar-A-Largoon Tuesday . He will be meeti ng 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-I-000359 Page 806 of 2~1i of 1380 Document ID: 0.7.1705.526850-000012 Owner : Blackburn , Scott R. Filename: RE: Update (11).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000360 Page 807 of 2~e~ of 1380 To:RE : Upd~Mdbm~J8~'na~JdAn'.ffir!8gwnwJg_~'ti)chment 12 of15) From: Blackburn, Scott R. Tue 3/27/2018 12:19:27 PM Subject: RE: Update Sent: Hmm. Have you spoken to the Secre tary direc tly yet? I wrote him about Marc Sherm an's email but he didn ' t respond. Not sure where his hea d is at. I don ' t understand why ogc would meet him without you. It kill s me how we don ' t trust each other and try to work point to point through the Secretary. Sent with Good (www.good.com) From: Windom, John H. Sent: Tuesday, March 27, 2018 6 :34: 17 AM To: Blackbu m, ScottR. Subject: Update Sir There was a meetin g between Shulkin and the attorneys (Byrne and Fleck ) last week that I was not invited to . Thi s is the language propo sed for inclu sion in the con tract following that meeting. Does the inclu sion of thi s language clo se the deal? Befor e nego tiatin g with Cerner , I need to under stand weather it clo ses the dea l. I discuss with the TAC thi s mornin g . Ju st rece ived yesterday eve . Thank you. John John , Ref erence is made to the not e I sent you last Wednesday whereby I mentioned that OGC (Mr. Byrne) wanted to re view our RFP. Mik e Kray c ino vich recently shared the following OGC reque sted PWS change (italicized) presumably as a res ult of that review : Plea se consider this recommend ed change to PWS Section 1.0 betwee n what is currently the first paragraph and the seco nd para graph -The proje ct has been awarde d via the public interest exce ption in FAR 6.302-7. The goa l of this accelerated award is to deliver a modernized sys tem in the best inter ests of Veterans, their hea lthca re, and the provid ers that care for them both inside the VA and in co mmer cial care settings . Thi s award contemplat es the provi sion of serv ices by Cerner Corporation, and accord ingly these document s referen ce Cerner Corporation and its softw are and ser vices. How eve r, the Gov ernm ent may determin e that in so me cases a diff erent source of softw are and /or servi ces will best support the public's inter est in areas such as quality of care, patient engagement, operational efficiency, or interop erab ility to fulfill the goa ls of Electronic Health Recor d Modernization , the Veterans' Choi ce program, or other reason as the Governme nt may dec ide. The Go vernme nt ma y requ ire perfor mance of part of this award by an alternativ e so urce in any such case , in acco rdance with procurement law s and regulation s. This may include , for exa mple , delivery of software or service s by another contractor within the Gove rnment' s comp etitiv e range for the D epartment of Defense ' s DHMSM as provide d in the Government's February 19, 2015 notic e. Sent with Good (www.goo d.com) VA-18-0298-I-000361 Page 808 of 2~e~ of 1380 Document ID: 0.7.1705.526850-000013 Owner : Blackburn , Scott R. Filename: RE: VACIO advisory support for Gerner contract (12).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000362 Page 809 of 2~e~ of 1380 To: RE: VAC/:?e\lR~Wi~~';t(lif Pa'HPn ~r~j:9ftilM~1lb~r@f>~?gdo/] From: Sent: Subject: PrintedItem:336 ( Attachment13 of 15) Blackburn, Scott R. Fri 11/3/2017 10:23:29 PM RE: VACIO advisory support for Gerner contract Thanks Avi. I managed to find the other 4 . I will shoot them all an email over the weekend. I'll cc you guys too in case you want to be included . Thanks for all the support. Have a great weekend, Scott From: Berkowitz, Avrahm J. EOP/WHOl(b)(6) ~who.eop.gov] Sent: Wedne sday, November 01, 2017 9:33 AM To: Blackburn, Scott R. Subject: [EXTERNAL]RE: VACIO advisory support for Cerner contract Richard D. Daniels !L (b_)(_6_ ) ____ ...J'k@ _kP~·-o~rg Here is the first he can help likely with the others - let me know if you need help tracking them down - I don ' t have them at the moment From: Blackb urn , Scott R.fmailto:S cott.Bl ac kburn@ va .gov] Sent: Tuesday, October 31, 2017 4:31 PM To: Berkowitz , Avrahm J. EOP/WH q (b)(6)W/who.eo p.go v> Subject: FW: VACIO advisory support for Cemer contract HiAvi, Happy Halloween! I just want to follow up on this exchange wit h Jared. Can you help connect us with the 5 CIOs so we can bounce our EHR plan off of them before we go final? Thanks again for all the support! Scott From: Kushner , Jared C. EOPIWHOl(b)(6) @who.eop .gov] Sent: Friday, October 27 , 2017 5:36 AM To: Blackburn, Scott R. Cc: Liddell, Christopher P. EOP/WHO; Windom, John H.; DJS; Berkowitz, Avrahm J. EOP/WHO; Dumbauld, Cas sidy M. EOP/WHO Subject: [EXTERNAL]Re: VA CIO advisory support for Cerner contract (b)(5) Avi will co nn ec t you and sched ule next meeting Sent from my iPhone On Oct 27, 2017 , at 1:56 AM, Blackburn, Scott R. wrote: Jared / Chris (b)(5) VA-18-0298-I-000363 Page 81 o of 2~1~ of 1380 RE: VAC IO advisory support for Cer1wr contract U 2) .JTISQ <~ tracted> for. Printed ltwuf· 336 ( Attachmetit l.3 of 15) co urse we wou10 Jove tor the two or you to Jom as well I you are ava11aule. (b)(5) Scott This is Scott Blackbw-n, the Acting CIO for the Department of Veterans Affairs (VA). On behalf of the Secretary David Shulkin, I would like to invite you to participate in a critical review of our Electronic Health Record (EHR)modernization strategy and corresponding Request for Proposal (RFP)to Cerner. Your organizations have been at the forefront of the evolution high quality IT-based health care services and delivery for decades, and thus we would be remiss if we did not seek to gain your insight prior to our final contracting decision. I anticipate a round table style engagement/discussion in the Washington, D.C. area that will last approximately two hours. I will be accompanied by the Program Executive Officer for VAElectronic Health Record Modernization (PEO EHRM),John Windom, and his key staff members including his Chief Medical Officer (CMO), ChiefTechno logy Officer (CTO)and Director of Contracts. We have spoken to many commercial health care industry leaders regarding EHRimplementation and deployment , and continue to maintain a strong relationship with our Department of Defense (DoD) counterpa rts, with regards to their EHRdeployment activities and related challenges. We believe that we have developed a comprehensive RFP with particular emphasis on notable "fail points" EHRdeployment arena such as Governance, Training, Change Management, Data Migration, Funding, etc. to name only a few, but look forward to your thoughts on these and others. I ask that you please provide me your primary schedule manager or point of contact to coordinate a date and time that maximizes our overall participation at this all-important review forum. Thank you in advance for your attention to this note, participation and willingness to help our Veterans continue to receive the very best healthcare. Scott Blackburn Scott Blackburn Acting CIO & Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000364 Page 8 11 of 2~1i of 1380 Document ID: 0.7.1705.526850-000014 Owner : Blackburn , Scott R. Filename: RE: VA MEETING (13).msg Last Modified: Sun Apr 08 11:45:30 CDT 2018 VA-18-0298-I-000365 Page 812 of 2~e~ of 1380 To: RE: VA ~Js~ for Printed Item: 336 ( Attachment 14 of 15) From: Blackburn, Scott R. Tue 11/ 14/20177:15:28PM Subject: RE: VA MEETING Sent: thanks From: DJS Sent: Tue sday, November 14, 20 17 2:15 PM To: Blackburn, Scott R. Subject: RE: VA MEETING Yes and yes Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:46:39 AM To: DJS Subject: RE: VA MEETING Got it. Are you ok with Bruce joining and inviting a few others (it looks like 1-2 clinicians from MGH)? For th e 5 CIOs who ask, I will tell them th at Bruce is an advisor and exte nsion of the WH/VA team. Is th a t ok to say? From: DJS Sent: Tue sday , November 14, 2017 1:43 PM To: Blackburn, Scott R. Subject: RE: VAMEETING I don't have any real advice but to keep the conversation focused on the topics you need advice and value on Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Tue sday , November 14, 2017 10:38:25 AM To: DJS Subject: FW: VA MEETING The call with th e 5 CIOs is Wednesday 3-Spm. On our p re -calls, 2 of th e CIOs have asked about Bruce and wha t his involvement is. I have neve r had any contac t with Bruce, but it seems like a sensi tive relationship. Any advice on ho w to han dle? We invited Jared/Chris from WH as a court esy. I don't think either plan to join, but th ey must have invited Bruce who is now asking a few others to join (see below). Can discuss live lat e r before or after hearin g prep. Scott From: Schnitzer , Jay Jl (b)(6) ~ mitre.org) Sent: Tue sday, November 14, 2017 12:47 PM To: Blackburn, Scott R. Cc: Wynn , Jackie VA-18-0298-I-000366 Page 8 13 of 2~1i of 1380 Hi Scott, Pl ease see the ema il trail below. Ju st wan t you aware in case we have people j oining the call wi thout your know ledge or approval. Thanks, Best , Jay Jay J. Sc hnit ze r, M .D. , Ph.D. MITRE Fro m : Noga, James l(b)(G) hvPARTNERS.ORG> Date: Tuesday, Nov 14, 20 17, 11:43 AM To : Karson, Andrew Scott,M.D. 1(b)(6) @mgh.harvard.edu> Cc: Schnitzer, Jay Jl(b)(6) @mitre.org> Subject: RE: VA MEETING But d o the people hosting th e call know you are going to be on the call? I am copying Jay as he is helping coordi nat e the call. Jim From: Karson, Andrew Scott ,M.D. Sent: Tuesday, November 14, 2017 11:31 AM To: Noga , James j(b)(6) ~PARTNERS.ORO> Subject: RE: VAMEETING Dear Jim, Tha nks for the not e. I think that you a nd I ma y have a little mis-under stan ding. I agree th at you can of course handle the call, but Gregg and Bruce Moskovitz invited me to th e call tomorrow so th at they can have a hand s-on clinicians perspective. Bruce and I spoke very briefly (b e tween his pa tien ts) a little while ago and Bruce sen t me the below informa tion. I am hoping to touch base with you before th e call if th a t is possible for yo u. I am tied up in pre se ntation s/ meetings the rest of th e da y, but co uld speak this eve ning (6pm?) or tomorrow if tha t is okay with you. (And if needed I will break o ut of othe r meetin gs today) . Many than ks, Andy From: Noga, James Sent: Tuesday, November 14, 20 17 11: 16 AM To: Karson, Andrew Scott ,M.D~(b)(6) pvmgh.h arva rd.edu> Subject: RE: VAMEETING I h ad a call with them toda y in prep for tomorrow's call. I appr eciate the offer but I don' t think it is my place to invite yo u. It needs to come from th e VA. From: Karson, Andrew Scott,M .D. Sent: Tuesday, Novem ber 14, 20 17 11: 11 AM To: Noga , James!(b)(6) @PARTNERS.ORO> Subject: FW: VAMEETING Dear Jim, Given some conflicts that Gregg has being a senior adviso r for the VA,Gregg has asked me to join the 3pm VA call tomorrow to be availab le for the clinician pe rsp ective. Wou ld you be up for a 15 minute check -in call with me at some poi nt tomorrow before the VAcall? If so, then I'll reach o ut to Susan Briggs to get us a time. Many th anks, Andy From : Karson, Andrew Scott ,M.D. Se nt: Tuesday, November 14, 20 17 11:06 AM To: 'Bruce Moskowitz l(b)(6) @mac.com> Subject: RE: VAMEETING VA-18-0298-I-000367 Page 814 of 2~1~ of 1380 RE: VA MEETING (13).msg for Printed Item: 336 ( Attachment 14 of 15) Dear Bruce, Ma ny th anks for th e no te . I'll review the below a litt le later today and I'll b e back in to uch. Ma ny th anks and bes t, Andy From: Bruce Mos kowi tz l(b)(6) Sent: Tuesday, Novem be r 14, 20 17 10:45 AM To: Karson, Andr ew Sco tt,M .D.l(b)(6) Subject: VA MEETING lwmac.com] l@mgh.harvard.edu> The call will take place this Wednesday, November 15th between 3:00 PM and 5:00 PM )___ Dial In Number: l~(b_)(_G Passcode: ~ j(b)(G) Thank you for your time and involvement. Some background information. These are my concerns as a clinician. Cerner does not have the ability to provide the following in the Choice Program: Trackin g duplicate testing Trackin g over utilization by providers Tracking duplicate presc riptions and medication errors. Tracking tests that were ordered, completed and results go to all physicians involved in the Veterans care Patient notification of critically abnormal results with follow up resolution Arranging appointment followup between the VA and Private sector Emerge ncy room visits in the private sector ability to access records immediately and VA physic ians notified of emergency care and followup Cemer has no registry to tract what Cardiac and orthopedic devices are implanted in case there is a recall of the device Automatic record transfer from the Choice Provider to the VA patient record with flagging new information to every VA health care worker A radiology platform to see films in high definition to compare X-rays and ability for radiologists to efficiently find previous films. For instance a radiologist needs to know if a lung nodule is new or was there previo usly and the same size. Cardiologists need to access catheterization films in high definiti on Cemer has no system to alert VA health care workers when a patient is at a particular office or hospital to participate in care management in real time. Sent from my iPad Bruce Moskowitz M .D . The information in this e-mail is intended only for the person to whom it is VA-18-0298-I-000368 Page 8 15 of 2~1iof 1380 RE: VA MEE.TING (j3) ..msg fo~rr inted Item: 336 ( Attachment 14 of 15)th . addressed . lt you be11evetms e-ma1 was sent to you m error and e e-ma11 contains patient information, please contact the Partners Compliance HelpLine at http://www.partners.org /compliance line . If the e-ma il was sent to you in en-or but does not contain patient information , plea se contact the sender and properly dispose of the e-mail. VA-18-0298-I-000369 Page 816 of 2~;!~ of 1380 Document ID: 0.7.1705.396079 Sandoval, Camilo J. Bruce Moskowitz To: l(b)(6) 1@mac .com> Cc: Bee: Subject: RE: [EXTERNAL] How is patient-centric interoperab ility leading the revolutionary healthcare transformation? Date: Mon Apr 02 2018 23:38:55 EDT Attachments: Thank you . Great article. -----Original Message----From: Bruce Moskowitz ~i (b-)(-6)-------~ @mac.com] Sent: Monday, April 02, 2018 6:35 AM To: Sandoval , Camilo J . Subject: [EXTERNAL] How is patient-centric interoperability leading the revolutionary healthcare transformation? https ://www.beckershospitalreview.com/healthcare-information-technology/how-is-patient-centricinteroperability -leading-the -revolutionary-healthcare-transformation.html Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000370 Page 848 of 2~1/o of 1380 Document ID: 0.7.1705.396077 From: Sandoval, Camilo J. To: Windom, John H. ; Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] How is patient-centric interoperability leading the revolutionary healthcare transformation? Date: Mon Apr 02 2018 23:38:23 EDT Attachments: -----Original Message----From: Bruce Moskowitz Sent: Monday, April 02, 2018 6:35 AM To: Sandoval , Camilo J. Subject: [EXTERNAL] How is patient-centric interoperab ility leading the revolutionary healthcare transformation? https://www.beckershospitalreview.com/healthcare-information-technology/how-is-patient-centricinteroperability-leading-the-revolutionary -healthcare-transformation.html Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000371 Page 849 of 2~ 7~of 1380 Good morning- Could you please send reading material/agenda for tomorrow's 1pm meeting with DEPSEC Bowman? Thank you l(b)(6) Special Assistant to the Deputy Secretary Office of the Secretary Department of Veterans Affairs ) __ (0)202-461-4822 (cj~(b_)(6_ ~ charlyn.isaac@va.gov < Caution-mai lto:char lyn.isaac@va.gov > From: Blackburn, Scott R. Sent: Tuesday , February 27, 2018 8:10 AM To : Cummings , Stacy A SES (US); Kurta , Anthony M SES OSD OUSD P-R (US) Cc: l(b)(6) IDevine , Daniel C. Subject: RE : Follow up at VA Absolutely . It will likely have to be the following week (that week is Spring break for my kids so will be taking the week off). CC'ing l(b)(6) Ito help us find a time . -----Original Message----From: Cummings , Stacy A SES (US) [Caution-mai lto:stacy.a.cummings.civ@mail.mi l < Caution-mailto: VA-18-0298-I-000372 Page 851 of 2~~ of 1380 stacy.a.cummings.civ@mail.mil >] Sent: Tuesday, February 27, 2018 8:05 AM To: Blackburn, Scott R.; Kurta, Anthony MSES OSD OUSD P-R (US) Subject: [EXTERNAL] Follow up at VA Scott, Nice seeing you last week and I expect our paths will cross at HIMSS next week. As we discussed, Tony Kurta and I would like to come over for an office visit with you and DEPSECVA in the next month or so. Can we shoot for the week of 26 March? Thanks and take care. See you both tomorrow morning at the Joint DoDN A steering committee meeting . Stacy Stacy A. Cummings Program Executive Officer Defense Healthcare Management Systems (DHMS) 703-588-8719 PEO DHMS: Transforming Healthcare Through Acquisition Excellence VA-18-0298-I-000373 Page 852 of 2~ 7~of 1380 Document ID: 0.7.1705.395233 Blackburn , Scott R. To: Sandoval, Camilo J. Cc: Windom , John H. Bee: Subject: RE: Contract Language Date: Mon Apr 02 2018 09:40:53 EDT Attachments: (b-)(_6 )____ Morris , Genevieve (OS/ONC/10 1._ _. ~hhs .gov I don't think I have a phone number for her , but will let you know if I can find it. From: Sandoval , Camilo J. Sent: Monday , April 02, 2018 9:03 AM To : Blackburn , Scott R. Cc: Windom , John H. Subject: RE: Contract Language Scott .Do you have Genevieve 's work email addre ss and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you , Camilo From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 6:28 :05 PM To: Sandoval , Camilo J. Cc: Windom, John H. Subject: RE: Contract Language Yep , I know Genevieve . She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandoval , Camilo J. VA-18-0298-I-000374 Page 876 of 2~1/a of 1380 Sent: Sunday, April 01, 2018 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Contract Language Excellent, I'll touch base with Windom tomorrow morning. Also , there 's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well, at least with regards to interoperability , and already working with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond just reviewing the Cerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperability? Camilo From: Blackburn , Scott R. Sent: Sunday , April 01 , 2018 4:38:47 PM To: Sandoval , Camilo J. Cc: Windom , John H. Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago. I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Camilo J. Sent: Sunday , April 01, 2018 7:35 PM To: Blackburn, Scott R. Cc: Windom , John H. Subject: Re: Contract Language VA-18-0298-I-000375 Page 877 of 2~ 7~of 1380 Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper, Stan Huff, Stephanie Reel, Jonathan Manis). Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000376 Page 878 of 2~ 7~of 1380 Document ID: 0.7.1705.395213 Sandoval, Camilo J. Blackburn, Scott R. Cc: Windom , John H. Bee: Subject: RE: Contract Language Date: Mon Apr 02 2018 09:03:27 EDT Attachments: Scott,Do you have Genevieve 's work email address and phone number? I need to contact her today and not sure where I can find her or if she at the VA yet. Thank you , Camilo From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 6:28 :05 PM To: Sandoval , Camilo J. Cc: Windom , John H. Subject: RE: Contract Language Yep , I know Genevieve . She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandoval , Camilo J. Sent: Sunday , April 01, 2018 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Contract Language Excellent, I'll touch base with Windom tomorrow morning. Also , there 's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well, at least with regards to interoperability , and already working with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond just reviewing the Gerner contract? She seems to have a solid policy background in her respective space . Do you see Genevieve and Rasu working together to cover the policy and functional VA-18-0298-I-000377 Page 882 of 2~ 7~of 1380 aspects of Interoperability? Camilo From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 4:38:47 PM To: Sandoval , Camilo J. Cc: Windom, John H. Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago. I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Camilo J. Sent: Sunday , April 01, 2018 7:35 PM To : Blackburn, Scott R. Cc: Windom , John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper, Stan Huff, Stephanie Reel, Jonathan Manis). Could you kindly forward me those emails and documents? I believe it was in regards to interoperability. Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000378 Page 883 of 2~ 7~of 1380 Document ID: 0.7.1705.519366 From: Blackburn, Scott R. To: Windom, John H. Cc: Bee: Subject: FW: Contract Language Date: Sun Apr 01 2018 22:26:06 EDT Attachments: Did you know anything about Genevieve Morris coming in? From: Sandoval , Cam ilo J. Sent: Sunday, April 01, 2018 8:39 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: RE: Contract Language Excellent, I'll touch base with Windom tomorrow morning. Also , there 's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well , at least with regards to interoperability , and already working with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her expert ise in combination with Rasu, beyond just reviewing the Gerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperability? Cam ilo From: Blackburn, Scott R. Sent: Sunday , April 01, 2018 4:38:47 PM To: Sandoval, Camilo J. Cc: Windom , John H. Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago. I believe John and VA-18-0298-I-000379 Page 892 of 2~ 7~of 1380 team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Cami lo J. Sent: Sunday , April 01, 2018 7:35 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several C IOs (Leslie Cooper, Stan Huff, Stephanie Reel , Jonathan Manis) . Could you kindly forward me those emai ls and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000380 Page 893 of 2~ 8~of 1380 Document ID: 0.7.1705.394769 From: Sandoval, Camilo J. To: Blackburn , Scott R. Cc: Bee: Subject: RE: Contract Language Date: Sun Apr 01 2018 21 :31 :05 EDT Attachments: Yes , she begins tmrw . No idea where she will be in the morning, but was asked to meet with here asap . From: Blackburn, Scott R. Sent: Sunday , April 01 , 2018 6:28 :05 PM To: Sandov al, Camilo J. Cc: Windom , John H. Subject: RE: Contract Language Yep , I know Genevieve . She is good . Will give it some thought. Is she detailed in to VHA I assume? From: Sandoval , Camilo J. Sent: Sunday , April 01 , 2018 8:39 PM To : Blackburn, Scott R. Cc: Windom , John H. Subject: RE: Contract Language Excellent , I'll touch base with Windom tomorrow morn ing. Also , there 's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well , at least with regards to interoperability , and already working with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond just reviewing the Gerner contract? She seems to have a solid policy background in her respective space. Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperability? Camilo VA-18-0298-I-000381 Page 894 of 2~ 8~of 1380 From: Blackburn, Scott R. Sent: Sunday , April 01, 2018 4:38:47 PM To: Sandoval, Camilo J. Cc: Windom , John H. Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago. I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Camilo J. Sent: Sunday , April 01, 2018 7:35 PM To : Blackburn, Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper, Stan Huff, Stephanie Reel, Jonathan Manis) . Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000382 Page 895 of 2~ 8~of 1380 Document ID: 0.7.1705.519286 Blackburn , Scott R. Sandova l, Cami lo J. Windom , John H. Bee: RE: Contract Language Subject: Sun Apr 01 20 18 21 :28:05 EDT Date: Attachments: Yep , I know Genevieve . She is good . Will give it some thought. Is she detai led in to VHA I assume? From: Sandoval , Cam ilo J. Sent: Sunday , Apr il 01 , 20 18 8:39 PM To : Blackburn , Scott R. Cc: W indom , John H. Subject: RE: Contract Language Excellent , I'll touch base with Windom tomorrow morn ing. A lso, there 's someone by the name of Genevieve Morr is from the Office of National Coord inator (ONC) joining the VA tomorrow on a 120 day detai l. I believe she will be helping us review the contract as we ll, at least with regard s to interoperability , and already wo rking with the EHR team . Do you know (of) her? Any thoughts on how we might utilize her experti se in comb ination with Rasu , beyond just reviewing the Gerner contract? She seems to have a solid policy background in her respective space . Do you see Genevieve and Rasu working together to cover the policy and functiona l aspects of Interoperability? Camilo From: Blackburn, Scott R. Sent: Sunday , Apr il 01 , 2018 4:38:47 PM To : Sandova l, Camilo J. Cc: W indom , John H. Subject: RE: Cont ract Language Not sure we did . John? VA-18-0298-I-000383 Page 896 of 2~ 8~of 1380 What he might be talking about is the feedback from the calls we had 2 weeks ago . I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback). There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Cami lo J. Sent: Sunday , April 01, 2018 7:35 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several C IOs (Leslie Cooper, Stan Huff, Stephanie Reel , Jonathan Manis). Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you . Camilo VA-18-0298-I-000384 Page 897 of 2~ 8~of 1380 Document ID: 0.7.1705.476376 Sandoval, Camilo J. Blackburn, Scott R. Windom , John H. Bee: RE: Contract Language Subject: Sun Apr 01 2018 20:38:40 EDT Date: Attachments: , Excellent , I'll touch base with Windom tomorrow morning. Also , there 's someone by the name of Genevieve Morris from the Office of National Coordinator (ONC) joining the VA tomorrow on a 120 day detail. I believe she will be helping us review the contract as well , at least with regards to interoperability , and already working with the EHR team. Do you know (of) her? Any thoughts on how we might utilize her expertise in combination with Rasu, beyond just reviewing the Gerner contract? She seems to have a solid policy background in her respective space . Do you see Genevieve and Rasu working together to cover the policy and functional aspects of Interoperability? Camilo From: Blackburn , Scott R. Sent: Sunday , April 01 , 2018 4:38:47 PM To: Sandoval, Camilo J. Cc: Windom, John H. Subject: RE: Contract Language Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago . I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. VA-18-0298-I-000385 Page 900 of 2~ 8~of 1380 From: Sandoval , Cami lo J. Sent: Sunday , April 01 , 2018 7:35 PM To: Blackburn, Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recent ly received language provided by several C IOs (Leslie Cooper, Stan Huff, Stephanie Reel , Jonathan Manis) . Could you kindly forward me those emai ls and documents? I believe it was in regards to interoperability. Hope you had a great Easter Sunday . Thank you. Camilo VA-18-0298-I-000386 Page 901 of 2~ 8~of 1380 Document ID: 0.7.1705.519253 Blackburn, Scott R. Sandova l, Cami lo J. Windom , John H. Bee: RE: Contract Language Subject: Sun Apr 01 2018 19:38:47 EDT Date: Attachments: , Not sure we did. John? What he might be talking about is the feedback from the calls we had 2 weeks ago. I believe John and team have created a thorough matrix to reconcile that feedback (and Ash did follow ups with each to make sure we understood their feedback and then understood how we were reconciling that feedback) . There was also the language that we received via OGC. I'll leave it to John to weigh in. From: Sandoval , Camilo J. Sent: Sunday , April 01 , 2018 7:35 PM To: Blackburn , Scott R. Cc: Windom, John H. Subject: Re: Contract Language Scott, I just spoke with Bruce Moskowitz regarding where things are with EHR and he mentioned you recently received language provided by several CIOs (Leslie Cooper, Stan Huff, Stephanie Reel , Jonathan Manis) . Could you kindly forward me those emails and documents? I believe it was in regards to interoperability . Hope you had a great Easter Sunday. Thank you. Camilo VA-18-0298-I-000387 Page 904 of 2~ 8~of 1380 Document ID: 0.7.1705.390940 From: Windom, John H. To: Blackburn, Scott R. (DISABLED ACCT) ; Bowman, Thomas (DISABLED ACCT) Cc: Zenooz, Ashwini ; Short , John (VACO) Bee: Subject: RE: [EXTERNAL] Re: VA EHR Date: Fri Mar 23 2018 13:54:36 EDT Attachments: Mr. Blackburn, I went back and read Mr. Sherman 's email and reviewed my notes . I see no recommended language for insertion in the contract to address his concerns. What it appears to be is a push to perform an interoperability sandbox/test platform in advance of contract award. 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 l.... 6)___ )(-'Mobile : (b"'"' ____. 6 Executive Assistant: Ms ..... l(b-)(_ l__ l(b_)(_6)_ .... _.l - Appointments and Scheduling ___, @va.gov Office : 202-382-3792 VA-18-0298-I-000388 Page 1003 of 2~1iof 1380 From: Windom, John H. Sent: Friday, March 23, 2018 1:47 PM To: Blackburn, Scott R.; Bowman, Thomas Cc: Zenooz, Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] Re: VA EHR Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consistent with the requirements or our Clinicians , various external reviews and the Mitre report. Mr. Sherman is seeking specificity in the interoperability realm that simply does not exist today and is evolving even as I type. We have provisions in the EHR contract to insert technology as we, the VA , as well as to incorporate evolving technology and standards . The DVP acquisition is our bridge to the use of APls (gateways), FHIR, etc. We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the recent phone call to stop Marc Sherman, et. Al's parade of national interoperability objectives as not feasible at this juncture "anywhere, " but included as part of our overall interoperability strategy that includes the DVP acquisition/strategy . We are committed to establishing the interoperability test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addition, I believe Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and their inclusion in the contract. They are clearly in the contract as captured below . Mr. Sherman does not understand the culture of VA or the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHR Modernization effort. He appears to be more of a "big bang" theory guy . The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulations/policies (e.g. cybersecurity, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology , innovation opportunities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice. Through the Initial Operating Capabilities (IOC) process and the judicious issuance of task orders , we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to recognize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas , not more words in the contract. V/r, John IDIQ PWS 5.5.1: Workflow Development and Normalization: j) The Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled external data. By IOC VA-18-0298-I-000389 Page 1004 of 2~ 8~of 1380 entry, the Contractor shall support incorpora tion of the following external community data domains, including but not limited to these domains and sub-domains: • Problems • Allergies • Home Medications • Procedures - including associated reports and with appropriately filtered CPT codes • Immunizations • Discharge Summaries • Progress Notes • Consult Notes • History & Physicals • Operative Notes • Radiology and Diagnostic Reports (Into "Documentation " component) By IOC exit, the Contractor sha ll support incorporation of the following external community data domains , including but not limited to these domains and sub-domains: • Results o Labs - Genera l - Pathology and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report" component) • Images IDIQ PWS Section 5.10.4: Seamless Interoperability/ Joint Industry Outreach includes significant detail on the topic. The interoperability section is copied below this table for reference. IDIQ PWS section 5.5.4 Data Exchange - Application Program Interface (AP I) Gateway also includes detail on the creation of strategic open APls . VA-18-0298-I-000390 Page 1005 of 2~ 9~of 1380 VA NF-177: Interoperability - Data Standards: The system shall support the use of the health data standards identified in the VA DoD Health Information Technical Standards Profile and by the VA DoD lnteragency Clinical Informatics board, including fo llowing common data standards: National Information Exchange Model NIEM; Health Level 7 HL7; Logical Observation Identifiers , Names and Codes LOINC ; Systematized Nomenclature of Medicine SNOMED; RxNorm , MedRT , ICD, CPT , HCPCS , Veteran Information Model VIM; and Healthcare Information Technology Standards Panel HITSP as well as VA/DOD/I PO extensions to these standards. VA-NF-T23: Informatics - Care Integration: VA must be able to seamlessly integrate with HIE and externa l-to-EHR shared services to provide for a seam less experience and to more effectively integrate in community care efforts, as well as with other parts of VA (e.g., identity management) . This includes but is not limited to the EHR product ability to support external shared services (SOA services, such as identity management, care plan service, scheduling, etc.) accessed via standards-based APls. (Process Continuity , Evolution , Extension) KSR5 [NOW+] VA NF-Z11 : Health Information Exchange: The system shall support VA electronic exchange of health records via other interoperable networks (e.g. CareQuality, CommonWell Health Alliance, DirectTrust , National Association for Trusted Exchange) by supporting their specifications, security and content specifications 5.10.4 Seamless Interoperability/ Joint Industry Outreach The Contractor is required to collaborate with VA affiliates, community partners, EHR providers, healthcare providers, and vendors to advance seamless care throughout the health care provider market. Seam less care will require the creation of an integrated inpatient and outpatient solution with software components that have been designed , integrated, maintained , and deployed with a design architecture that allows for access to and sharing of common data and an enab ling security framework that supports end-to-end healthcare related clinical and business operations. Seamless care is the experience patients and providers have moving from task to task and encounter to encounter within or between organizations such that high-q uality decisions form easily and comp lete care plans execute smoothly. Information systems support the seamless-care experience by gathering data, interpreting data, presenting information , and managing tasks . Currently, industry lacks specific and uniform interoperability standards to support seamless care between organizations that employ different EHR systems. The Requirements Traceability Matrix Section D, Attachment 003, sets forth specific Informatics and Interoperability contract requirements. To accomplish this , the Contractor shall provide software and serv ices to enable seamless care between VA encounters , encounters with other Government healthcare institutions , and outside entities through advancements in all areas of the EHR that occur. In addition, the software and services shall support the VA designated standards, such as SMART on FHIR and SMART-enabled applications, or other published standards. The objective of these interoperability solutions is to advance the state of the art supporting seamless care for Veterans . Existing organizations promoting interoperability among EHR vendors , such as The Argonaut Project , have developed or are planning to develop technology standards or technical approaches that may support the EHRM seamless care strategy . To the extent that underlying third party technology is available or made available to meet the following timelines, the following interoperability software solutions and services shall be delivered under this section: VA-18-0298-I-000391 Page 1006 of 2~ 9~of 1380 a) By Initial Operating Capability (IOC}, the Contractor shall provide a software solution enabling VA, DoD and community providers who have connected to the EHRM to share interactive care plans (ICPs) for Veterans. ICPs will enable collaborative communication between providers, and between providers and Veterans, in managing Veteran care. b) Within 24 months of applicable task order award , the Contractor shall provide a software solution enabling VA, DoD and connected community providers to complete referral management activities for Veterans . c) By IOC, the Contractor shall provide a software solution enabling VA to release and consume, via on-demand access , a Veteran's complete longitudinal health record to and from DoD and connected community partners, irrespective of which EHR they use, provided such EHR technology is certified by the Health and Human Services Office of the National Coordinator (ONC) or its successor . The longitudinal record solution shall support Provider-to-Provider record sharing , as well as ProviderVeteran-Provider sharing (Veteran mediated record sharing) , including appropriate consent management. The bi-directional health information exchange shall maximize use of discrete data that supports context-driven clinical decisions and informatics . d) Within 24 months of applicable task order award , the Contractor shall provide a software solution enabling connected VA , DoD and community providers connected to the EHRM to send and receive Admission/Discharge/Transfer notifications "pushed " from the provider initiating a Veteran care event to enable proactive engagement by VA care coordinators when notified of a Veteran care event. e) Within 24 months of applicable task order award , the Contractor will demonstrate a solution for identification and management of Veterans at high risk of suicide , in collaboration with community partners. f) By IOC, the contractor shall provide URL based image access to the VA, community and academic partner systems who can support the URL and a viewer to the providers via the health information exchange networks. Within 36 months of applicable task order award , the Contractor shall provide a software solution enabling VA , DoD and community providers connected to the EHRM to have nationwide access to Veterans ' imaging associated with diagnostic tests. g) By IOC, the Contractor shall provide a software solution for multilateral standards-based ingestion , normalization, storage, and exporting of Health Information Exchange acquired Veteran health information. The Contractor shall ensure that the solution provides a computable dataset for purposes of population health and research analytics, clinical decision support, and workflow integration. h) By IOC, the Contractor shall provide the capability to connect and exchange VA electronic health records via other interoperable networks , such as. eHealth Exchange, CareQuality , CommonWell Health Alliance , DirectTrust, National Association for Trusted Exchange by supporting their specifications , security and content specifications . Contractor shall support network record locator services and patient provider associations as applicable in accordance with applicable technical standards and the Trusted Exchange Framework and Common Agreement (TEFCA). i) By IOC, the Contractor shall provide a capability for provider collaboration via secure e-mail using the ONC Direct protocol or future VA-designated standard within a Gerner Millennium EHR workflow context. j) Within 36 months of applicable task order award , the Contractor shall provide a solution for a Software Development Kit (SOK) enabling standards-based applications (e.g., SMART, FHIR , etc.) integrated with EHRM solutions and platforms. k) Gerner shall deliver annually an Interoperability Plan to the VA on how it intends to meet the objectives established in PWS section 5.10.4 . The initial plan will be due within 3 months of applicable TO award . VA-18-0298-I-000392 Page 1007 of 2~ 9~of 1380 I) The Contractor shall conduct an annual Interoperability Self-Assessment against standards that shall be specified by VA, such as those promulgated by HIMSS or future standards to be identified by VA. The annual self assessment shall report on the state of each data element (e.g., which are supported in what capacities and in which formats). This will help assure standards implementation consistency and assure standards comp liance with evolving national standards . m) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies , clinical decision support rules, and 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., clinica l professional societies. 5.10.4.1 Data Design and Information Sharing In support of the interoperabi lity objectives under this Section, agreed upon Contractor proprietary information/data model extension points (e.g., ingestion and record APls) may be provided to both international and national standards designating organizations as described and set forth in an applicable Task Order. The Contractor shall provide VA access and usage rights into any underlying proprietary terminology/code systems for the purpose of enhancing nationa l standards to address any gaps identified in the EHRM solution. The Contractor shall also make the interoperability capabilities and product enhancements developed under this contract ava ilable to non-VA Gerner clients. 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VA anticipates developing a Digital Health Platform/Digital Veterans Platform (DVP) to consolidate critical VA EHR and non-EHR operational systems. The Contractor shall integrate the EHRM to interoperate with DVP, or future state VA platform , including the DVP API gateway or any other method designated by VA . 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_)(G _) ___ _ 5 Executive Assistant: Ms. ~l (b-)(_ l__ ~I - Appointments and Scheduling VA-18-0298-I-000393 Page 1008 of 2~1~ of 1380 6 1(b_)(_ )__ ..... _,@va .gov Office : 202-382-3792 From: Blackburn, Scott R. Sent: Friday, March 23, 2018 12:15 PM To : Windom, John H.; Bowman , Thomas Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary/Deputy 's office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To : Blackburn , Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts w ith whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required, defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . VA-18-0298-I-000394 Page 1009 of 2~1iof 1380 The best "oversight and management of the contract" will not turn a contract lacking specificity vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what expected so that today it can confirm its agreement to provide the full functionality desired and better understanding of what is expected of them. Clarity in the contract is a healthy ingredient VA and the Contractor . into a is have a for the I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone , but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively min imal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highl ights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). VA-18-0298-I-000395 Page 1010 of 2~ 9~of 1380 o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions . After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is -5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week) . We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change VA-18-0298-I-000396 Page 1011 of 2~ 9~of 1380 management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments, the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperability will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . Scott From: Marc Sherman l(b)(6) l@gmail.com] Sent: Wednesday, March 21, 2018 9:31 AM To : Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling. Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost , better healthcare delivery , etc. Then, with the standard fully defined and set in the original VA-18-0298-I-000397 Page 1012 of 2~1~ of 1380 PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after cost ly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong , it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seem ingly caused by a user (clinician) revolt over inad equacy (or unsuitability) for their needs. The VA runs that same risk . Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractua lly prevent similar mistakes . 3.1have other thoughts as well that we shou ld discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. From: Marc Sherman [mailto:mbsherman@gmail.com] Sent: Wednesday , March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I canno t move. I will catch up with you or Bruce after. Marc Marc Sherman VA-18-0298-I-000398 Page 1013 of 2~ 9~of 1380 (202) 758-8700 On Tue, Mar 20 , 2018, 10:30 PM Blackburn , Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite , but just in case it is l(b)(G) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge , Office of Informat ion & Technology US Department of Veterans Affair s VA-18-0298-I-000399 Page 10 14 of 2~1iof 1380 Document ID: 0.7.1705.1547215 From: Windom, John H. To: Blackburn, Scott R. ; Bowman, Tho mas Cc: Zenooz, Ashwini ; Short , John (VACO) Bee: Subject: RE: [EXTERNAL ] Re: VA EHR Date: Fri Mar 23 2018 13:47:03 EDT Attachments: Mr. Blackburn, Not sure where Mr. Sherman is going with his comments but our language in the contract is consis tent with the requirements or our Clinicians , various external reviews and the Mitre report. Mr. Sherman is seeking spec ificity in the interoperability realm that simply does not exist today and is evolving even as I type. We have provisions in the EHR contract to insert technology as we, the VA , as well as to incorporate evo lving technology and standa rds. The DVP acquis ition is our bridge to the use of APls (gateways), FHIR, etc. We have modified our interoperability language (below) based on the Mitre and the many external reviews to give us the utmost flexibility over the 10-year life of this contract. The Secretary personally halted the recent phone call to stop Marc Sherman, et. Al's parade of national interoperability objectives as not feasible at this juncture "anywhere, " but included as part of our overall interoperability strategy that includes the DVP acquisition/strategy . We are committed to estab lishing the interoperability test bed/sandbox at IOC to solidify our interoperability objectives prior to full deployment to the enterprise. In addit ion, I believe Mr. Sherman meant to highlight section 5.5.1 which speaks to the data domains that were called into question and the ir inclusion in the contract. They are clearly in the contract as captured below . Mr. Sherman does not understand the culture of VA or the federal government. We have an incremental/iterative change management strategy that will culminate in a successful EHR Modernization effort. He appears to be more of a "big bang" theory guy. The problem is, we must continue to deliver uninterrupted and quality care to our Veterans during the transformation within the parameters of the law and other regulations/policies (e.g. cybersecurity, cloud, etc.) bounding our integration/implementation strategies. Our existing language is sound and appropriately balances change management risks, future insertion of technology , innovation opportun ities, standards development, etc. without artificially inflating the cost of the contract through the incorporation of excess specificity that never materializes in practice . Through the Initial Operating Capabilities (IOC) process and the judicious issuance of task orders, we will have the ability to change course direction as appropriate without excess risk to the taxpayers or our overall success. Mr. Sherman continues to fail to recognize that it is Program Management Oversight (PMO) and VA commitment to change management that will drive our success in these areas, not more words in the contract. V/r, John VA-18-0298-I-000400 Page 1015 of 2io~of 1380 IDIQ PWS 5.5.1: Workflow Development and Normalization: j) The Contractor shall enable configuration of the application that supports external community data without requiring the clinician to go to special screens to see and use reconciled external data. By IOC entry , the Contractor shall support incorporation of the following external community data domains , including but not limited to these domains and sub-doma ins: • Problems • Allergies • Home Medications • Procedures - including associated reports and with appropriately filtered CPT codes • Immunizations • Discharge Summa ries • Progress Notes • Consult Notes • History & Physicals • Operative Notes • Radiology and Diagnostic Reports (Into "Documentation" component) By IOC exit, the Contractor sha ll support incorporation of the following external community data domains , including but not limited to these domains and sub-doma ins: • Results o Labs - General - Pathology and Microbiology o Vitals • Radiology and Diagnostic Reports (Into "Diagnostic Report" component) • Images IDIQ PWS Section 5.10.4: Seamless Interoperab ility/ Joint Industry Outreach includes significant detail on the topic. The interoperab ility section is copied below this table for reference. VA-18-0298-I-000401 Page 1016 of 2io~of 1380 IDIQ PWS section 5.5.4 Data Exchange - Application Program Interface (API) Gateway also includes detail on the creation of strategic open APls. VA NF-177: Interoperability - Data Standards: The system shall support the use of the health data standards identified in the VA DoD Health Information Technical Standards Profile and by the VA DoD lnteragency Clinical Informatics board, including following common data standards: National Information Exchange Model NIEM; Health Level 7 HL7; Logical Observation Identifiers , Names and Codes LOINC ; Systematized Nomenclature of Medicine SNOMED; RxNorm , MedRT, ICD, CPT, HCPCS, Veteran Information Model VIM; and Healthcare Information Technology Standards Panel HITSP as well as VA/DOD/I PO extensions to these standards. VA-NF-T23: Informatics - Care Integration: VA must be able to seamlessly integrate with HIE and externa l-to-EHR shared services to provide for a seam less exper ience and to more effectively integrate in community care efforts, as well as with other parts of VA (e.g., identity management). This includes but is not limited to the EHR product ability to support external shared services (SOA services, such as identity management , care plan service, scheduling, etc.) accessed via standards-based APls. (Process Continuity , Evolution , Extension) KSR5 [NOW+] VA NF-Z11 : Health Information Exchange: The system shall support VA electronic exchange of health records via other interoperable networks (e.g. CareQuality, CommonWell Health Alliance , DirectTrust, National Association for Trusted Exchange) by supporting their specifications, security and content specifications 5.10.4 Seamless Interoperability/ Joint Industry Outreach The Contractor is required to collaborate with VA affiliates, community partners, EHR providers, healthcare providers, and vendors to advance seamless care throughout the health care provider market. Seamless care will require the creation of an integrated inpatient and outpatient solution with software components that have been designed , integrated , maintained, and deployed with a design architecture that allows for access to and sharing of common data and an enab ling security framework that supports end-to-end healthcare related clinical and business operations. Seamless care is the experience patients and providers have moving from task to task and encounter to encounter within or between organizations such that high-quality decisions form easily and comp lete care plans execute smoothly. Information systems support the seamless-care experience by gathering data, interpret ing data, presenting information, and managing tasks. Currently, industry lacks specific and uniform interoperability standards to support seamless care between organizations that employ different EHR systems. The Requirements Traceability Matrix Section D, Attachment 003, sets forth specific Informatics and Interoperability contract requirements. To accomplish this , the Contractor shall provide software and services to enable seamless care between VA encounters , encounters with other Government healthcare institutions, and outside entities through advancements in all areas of the EHR that occur. In addition, the software and serv ices shall support the VA designated standards, such as SMART on FHIR and SMART-enabled applications, or other published standards. The objective of these interoperability solutions is to advance the state of the art supporting seamless VA-18-0298-I-000402 Page 1017 of 2i o~ of 1380 care for Veterans . Existing organizations promoting interoperability among EHR vendors , such as The Argonaut Project , have developed or are planning to develop technology standards or technical approaches that may support the EHRM seamless care strategy. To the extent that underlying third party technology is available or made available to meet the following timelines, the following interoperability software solutions and services shall be delivered under this section: a) By Initial Operating Capability (IOC), the Contractor shall provide a software solution enabling VA, DoD and community providers who have connected to the EHRM to share interactive care plans (ICPs) for Veterans. ICPs will enable collaborative communication between providers, and between providers and Veterans , in managing Veteran care. b) Within 24 months of applicable task order award , the Contractor shall provide a software solution enabling VA, DoD and connected community providers to complete referral management activities for Veterans . c) By IOC, the Contractor shall provide a software solution enabling VA to release and consume, via on-demand access , a Veteran's complete longitudinal health record to and from DoD and connected community partners, irrespective of which EHR they use , provided such EHR technology is certified by the Health and Human Services Office of the National Coordinator (ONC) or its successor . The longitudinal record solution shall support Provider-to-Provider record sharing, as well as ProviderVeteran-Provider sharing (Veteran mediated record sharing) , including appropriate consent management. The bi-directional health information exchange shall maximize use of discrete data that supports context-driven clinical decisions and informatics. d) Within 24 months of applicable task order award , the Contractor shall provide a software solution enabling connected VA , DoD and community providers connected to the EHRM to send and receive Admission/Discharge/Transfer notifications "pushed " from the provider initiating a Veteran care event to enable proactive engagement by VA care coordinators when notified of a Veteran care event. e) Within 24 months of applicable task order award , the Contractor will demonstrate a solution for identification and management of Veterans at high risk of suicide , in collaboration with community partners. f) By IOC, the contractor shall provide URL based image access to the VA, community and academic partner systems who can support the URL and a viewer to the providers via the health information exchange networks. Within 36 months of applicable task order award , the Contractor shall provide a software solution enabling VA, DoD and community providers connected to the EHRM to have nationwide access to Veterans' imaging associated with diagnostic tests. g) By IOC, the Contractor shall provide a software solution for multilateral standards-based ingestion, normalization , storage , and exporting of Health Information Exchange acquired Veteran health information . The Contractor shall ensure that the solution provides a computable dataset for purposes of population health and research analytics, clinical decision support, and workflow integration. h) By IOC, the Contractor shall provide the capability to connect and exchange VA electronic health records via other interoperable networks , such as. eHealth Exchange, CareQuality, CommonWell Health Alliance , DirectTrust, National Association for Trusted Exchange by supporting their specifications , security and content specifications. Contractor shall support network record locator services and patient provider associations as applicable in accordance with applicable technical standards and the Trusted Exchange Framework and Common Agreement (TEFCA). i) By IOC, the Contractor shall provide a capability for provider collaboration via secure e-mail using the ONC Direct protocol or future VA-designated standard within a Gerner Millennium EHR workflow context. j) Within 36 months of applicable task order award , the Contractor shall provide a solution for a VA-18-0298-I-000403 Page 1018 of 2~ 0~of 1380 Software Development Kit (SDK) enabling standards-based applications (e.g., SMART, FHIR, etc.) integrated with EHRM solutions and platforms . k) Gerner shall deliver annually an Interoperability Plan to the VA on how it intends to meet the objectives established in PWS section 5.10.4 . The initial plan will be due within 3 months of applicable TO award. I) The Contractor shall conduct an annual Interoperability Self-Assessment against standards that shall be specified by VA, such as those promulgated by HIMSS or future standards to be identified by VA. The annual self assessment shall report on the state of each data element (e.g. , which are supported in what capacities and in which formats). This will help assure standards implementation consistency and assure standards compliance with evolving national standards . m) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies , clinical decision support rules, and order sets, etc., to the extent such extensions are consistent with the model and best practices of the controll ing 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. 5.10.4.1 Data Design and Information Sharing In support of the interoperability objectives under this Section , agreed upon Contractor proprietary information/data model extension points (e.g., ingestion and record APls) may be provided to both international and national standards designating organizations as described and set forth in an applicable Task Order. The Contractor shall provide VA access and usage rights into any underlying proprietary terminology/code systems for the purpose of enhancing national standards to address any gaps identified in the EHRM solution . The Contractor shall also make the interoperability capabilities and product enhancements developed under this contract available to non-VA Gerner clients. 5.10.4.2 VA Digital Health Platform/Digital Veterans Platform Integration VA anticipates developing a Digital Health Platform/Digital Veterans Platform (DVP) to consolidate critical VA EHR and non-EHR operational systems. The Contractor shall integrate the EHRM to interoperate with DVP , or future state VA platform , including the DVP API gateway or any other method designated by VA. 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 VA-18-0298-I-000404 Page 10 19 of 2io~of 1380 Office: (202) 461-5820 Mobile J,__ (b_)(_ S)___ __, Executive Assistant: Ms.,__l (b_)(_6)__ _,~ Appointments and Scheduling l._ (b_)(S _)_ __.@va .gov Office: 202-382-3792 From: Blackburn, Scott R. Sent: Friday, March 23 , 2018 12:15 PM To : Windom, John H.; Bowman, Thoma s Subject: FW: [EXTERNAL] Re: VA EHR John - you might want to swing the by Secretary/Deputy 's office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday, March 23 , 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts. You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom VA-18-0298-I-000405 Page 1020 of 2~b~ of 1380 you consulted; and the experts are in fact not swayed by the follow-up conversations with them. The experts are recommending a system for the VA that has various enhancements to today's standard system functionality. At a minimum, I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non -standa rd) functional ity (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose. The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functional ity desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the cont ract provides this specificity that Ors. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included, which are enhancements of today's standard deliverables, the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However , when you substitute this concept for clear, written and defined functionality, especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identica l situations I just see warning flares going off . Scott, I want to see this project get started, and quickly, as much as anyone, but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract languag e in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce, Thank you once again for all your support and especially fo r linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: * In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we VA-18-0298-I-000406 Page 1021 of 2io~ of 1380 are on the same page and have the language right (part was us better understanding pointing him to the specific language in 5.1.1 and giving him the broader context with with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Partners). his point; part was what we are doing institutions signed Karson at o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Gerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date . If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. * Per Stephanie 's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic) , Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. * As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . * Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers . Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions . * After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we absolutely do not antic ipate any push back ; and Gerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand". * Marc makes a great point below on turning DoD's struggles into a positive. We have been VA-18-0298-I-000407 Page 1022 of 2i o~ of 1380 working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g. , data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers). We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . Th is will make getting move on change management in Task Order #1 so important. * As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors. " I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc .) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott l@gmail.com] From: Marc Sherman l(b)(6 ) Sent: Wednesday , March 21, 2018 9:31 AM To: Blackburn , Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation , a very costly result. Perhaps a similar VA-18-0298-I-000408 Page 1023 of 2~bi of 1380 problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed , Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote : No problem Marc. Thanks for all your help . Very helpful call last night. From: Marc Sherman l(b)(S) @gmail.com] Sent: Wednesday , March 21 , 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. VA-18-0298-I-000409 Page 1024 of 2~bi of 1380 Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am. just in case it is l(b)(G) I I assume you have the calendar invite, but We have been unable to schedule anything with Dr. Ko (very busy calendar). We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000410 Page 1025 of 2~ ~iof 1380 Document ID: 0.7.1705.1545275 From: Zenooz, Ashwini To: Blackburn, Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Re : VA EHR Date: Fri Mar 23 2018 12:36:42 EDT Attachments: Will do Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Friday, March 23, 2018 9:34:21 AM To: Zenooz, Ashwini; Short, John (VACO) Subject: RE: [EXTERNAL] Re : VA EHR Share this with Windom so he has this when he talks to the Secretary. Marc doesn't under stand what is in the contract. Sent with Good (www.good.com) From: Zenooz, Ashwini Sent: Friday , March 23, 2018 12:24 :36 PM To: Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] Re : VA EHR Interesting. Btw, I think Dr. Cooper's questions were answered in 5.5.1 but I will double check. Dr. Karson was very happy we had drilled down into medical devices and integration. I had forwarded you the sections I discussed with him. I know Short was connecting with Stan and Rasu on technical elements but you saw my note that Gerner will stand up the FHIR term server. Stephanie has been supportive and I have already sent her our mock cases and she said she will VA-18-0298-I-000411 Page 1026 of 2il~ of 1380 volunteer her people to help us with it. I'm very lost in what else is missing here. Thank you for sending this to us. Ash Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Friday, March 23, 2018 9:16:15 AM To : Zenooz, Ashwini; Short, John (VACO) Subject: FW: [EXTERNAL] Re: VA EHR I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn , Scott R. Cc: Bruce Moskowitz; DJS Subject: [EXTERNA L] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goa l to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to exp lain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consu lted; and the experts are in fact not swayed by the follow-up conve rsations with them. The experts are recommend ing a system for the VA that has various enhancements to today's standard system functiona lity. At a minimum , I heard those experts express their opinions that the contract VA-18-0298-I-000412 Page 1027 of 2il~ of 1380 dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose. The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity . Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff , for example, urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However , when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point ; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone , but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road . I also believe these things are easy to resolve in the contract language in relatively min imal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr . Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part VA-18-0298-I-000413 Pa ge 1028 of 2~ l~ of 1380 was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VNDoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions . After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I VA-18-0298-I-000414 Pa ge 1029 of 2il~ of 1380 am there so much; John and I work very closely with their EHR lead Stacy Cummings; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g. , data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperab ility will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . Scott From: Marc Sherman l(b)(6) l@gmail.com] Sent: Wednesday , March 21, 2018 9:31 AM To : Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are VA-18-0298-I-000415 Page 1030 of 2~~~ of 1380 rebelling. Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design, happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1 was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk . Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the ve ry system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1 have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today . Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. ~gmail.com] From: Marc Sherman l(b)(6) Sent: Wednesday , March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. VA-18-0298-I-000416 Page 1031 of 2~ ~iof 1380 Marc Marc Sherman (202) 758-8700 On Tue , Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calendar invite , but just in case it is l(b)( 6 ) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000417 Page 1032 of 2~~~ of 1380 Document ID: 0.7.1705.1775625 From: Blackburn, Scott R. To: Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: RE: [EXTERNAL ] Re: VA EHR Date: Fri Mar 23 2018 12:34:21 EDT Attachments: Share this with Windom so he has this when he talks to the Secretary . Marc doesn't understand what is in the contract. Sent with Good (www.good.com) From: Zenooz , Ashwini Sent: Friday, March 23, 2018 12:24:36 PM To: Blackburn, Scott R.; Short, John (VACO) Subj ect: RE: [EXTERNAL] Re: VA EHR Interesting. Btw , I think Dr. Cooper's questions were answered in 5.5.1 but I will double check. Dr. Karson was very happy we had drilled down into medical devices and integration. I had forwarded you the sections I discussed with him . I know Short was connecting with Stan and Rasu on technical elements but you saw my note that Cerner will stand up the FHIR term server. Stephanie has been supportive and I have already sent her our mock cases and she said she will volunteer her people to help us with it. I'm very lost in what else is missing here . Thank you for sending this to us. Ash Sent with Good (www.good .com) VA-18-0298-I-000418 Page 1033 of 2~l~of 1380 From: Blackburn, Scott R. Sent: Friday, March 23 , 2018 9:16:15 AM To: Zenooz, Ashwini; Short, John (VACO) Subject: FW: [EXTERNAL] Re: VA EHR I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts. You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However , there were several major issues raised in the calls this week with the technical and clinical experts that you try to exp lain away in your email as solved, but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer, but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow -up conversations with them . The experts are recommending a system for the VA that has various enhancements to today 's standard system functionality. At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required , defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractua l clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff , for example, urged. In light of the system requirements that these experts say must be included, which are enhancements of today's standard deliverables, the contract language is ambiguous. You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique VA-18-0298-I-000419 Page 1034 of 2~l~of 1380 in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off . Scott, I want to see this project get started, and quickly , as much as anyone, but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time . Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr . Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point ; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date . If V A/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow VA-18-0298-I-000420 Page 1035 of 2~ 2~of 1380 for continuity of expertise throughout our journey . Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we absolutely do not anticipate any push back; and Gerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA. .. something we heard loud and clear from Bruce!) , help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors ." I think we have a VA-18-0298-I-000421 Page 1036 of 2~ 2~of 1380 great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract, and more impo rtantly the proper oversight and management of the contract will greatly mit igate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperabil ity remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and correspondi ng requirements . Interoperab ility will be a moving target for years to co me , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant cos ts you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demand ing partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott @gmail. com] From: Marc Sherman l(b)(G) Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting speci fic definitions and standa rds on the meaning and use of "interoperability ," especially since that term has as many meanings in the indu stry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different sta ndard . That runs the risk of not being discovered until later , perhaps even up to implementation, a very costly resu lt. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fa irness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract VA-18-0298-I-000422 Page 1037 of 2~1~ of 1380 language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction . 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss , but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc. Thanks for all your help . Very helpful call last night. From: Marc Sherman l(b)(G) ~gmail.com] Sent: Wednesday , March 21 , 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . VA-18-0298-I-000423 Page 1038 of 2~1~ of 1380 We have Stan Huff from lntermountain tomorrow at 10am. I assume you have the calendar invite , but just in case it is J(b)(G) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000424 Page 1039 of 2~1iof 1380 Document ID: 0.7.1705.512183 From: Blackburn, Scott R. To: Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Re: VA EHR Fri Mar 23 2018 12:34:21 EDT Date: Attachments: Share this with Windom so he has this when he talks to the Secretary . Marc doesn't understand what is in the contract. Sent with Good (www.good .com) From: Zenooz , Ashwini Sent: Friday, March 23, 2018 12:24:36 PM To: Blackburn, Scott R.; Short, John (VACO) Subject: RE: [EXTERNAL] Re: VA EHR Intere sting. Btw, I think Dr. Cooper's questions were answered in 5.5.1 but I will double check. Dr. Karson was very happy we had drilled down into medical devices and integration. I had forwarded you the sections I discussed with him. I know Short was connecting with Stan and Rasu on technical elements but you saw my note that Cerner will stand up the FHIR term server . Stephanie has been supportive and I have already sent her our mock cases and she said she will volunteer her people to help us with it. I'm very lost in what else is missing here. Thank you for sending this to us. Ash Sent with Good (www.good.com) VA-18-0298-I-000425 Pa ge 1040 of 2i 2~of 1380 From: Blackburn, Scott R. Sent: Friday, March 23, 2018 9:16:15 AM To: Zenooz , Ashwini; Short , John (VACO) Subject: FW: [EXTERNAL] Re: VA EHR I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required, defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity . Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system VA-18-0298-I-000426 Pag e 1041 of 2i 2~of 1380 requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone, but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo . o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VNDoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000427 Pa ge 104 2 of 2i 2~of 1380 Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo), Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we absolutely do not anticipate any push back; and Gerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take -2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys, infrastructure readiness, data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is -5% of the value of the contract). But this will allow us to get moving and out of the "quicksand" . Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . Th is will make getting move on change management in Task Order #1 so important. VA-18-0298-I-000428 Pa ge 1043 of 2i 2~of 1380 As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors ." I think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott From: Marc Sherman !(b)(G) i@gmail.com] Sent: Wednesday , March 21 , 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subje ct: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost , better healthcare delivery , etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns VA-18-0298-I-000429 Page 1044 of 2~1iof 1380 they may have now instead of in the future after cost ly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulk in pushed back on Dr. Cooper's v iew as already accomp lished in the PWS and cited Sect ion 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defin ing language to set out unambiguous definit ions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it wou ld be usefu l for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementat ion seem ingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that prob lem cou ld be a benefit to your effort. Why not accumulate all of the user compla ints/ issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA imp lementation and include them in the contract as definitiona l requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we shou ld discuss, but these are the ones that I felt more pressing to high light since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote : No problem Marc . Thanks for all your help. Very helpful call last night. From: Marc Sherman l(b)(6) l@gmail.com] Sent: Wednesday , March 21 , 2018 12:12 AM To: Blackburn , Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote : VA-18-0298-I-000430 Page 1045 of 2~\i of 1380 Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calendar invite , but just in case it isl(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge, Office of Informat ion & Technology US Department of Veterans Affairs VA-18-0298-I-000431 Page 1046 of 2~\~ of 1380 Document ID: 0.7.1705.1545259 From: Zenooz, Ashwini To: Blackburn, Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Re : VA EHR Date: Fri Mar 23 2018 12:24 :36 EDT Attachments: Interesting . Btw , I think Dr . Cooper's questions were answered in 5.5.1 but I will double check. Dr. Karson was very happy we had drilled down into medical devices and integration. I had forwarded you the sections I discussed with him . I know Short was connecting with Stan and Rasu on technical elements but you saw my note that Gerner will stand up the FHIR term server. Stephanie has been supportive and I have already sent her our mock cases and she said she will volunteer her people to help us with it. I'm very lost in what else is missing here. Thank you for sending this to us. Ash Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Friday, March 23, 2018 9:16:15 AM To: Zenooz, Ashwini; Short, John (VACO) Subject: FW: [EXTERNAL] Re: VA EHR I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions . Sent with Good (www.good.com) VA-18-0298-I-000432 Page 104 7 of 2i 3~of 1380 From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However , there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers . I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts w ith whom you consulted; and the experts are in fact not swayed by the follow-up conversation s with them. The experts are recommending a system for the VA that has various enhancements to today 's standard system functionality. At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions , standards and a clear expression of this required , defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity . Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor . I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Drs. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables, the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe . However , when you substitute this concept for clear, written and defined functionality, especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone , but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. VA-18-0298-I-000433 Page 1048 of 2~j~ of 1380 Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VNDoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie 's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and VA-18-0298-I-000434 Pa ge 1049 of 2i 3~of 1380 also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we absolutely do not anticipate any push back; and Gerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take -2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys, infrastructure readiness, data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week) . We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow , change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors. " I think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperab ility will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . VA-18-0298-I-000435 Pa ge 1050 of 2i!~ of 1380 Scott From: Marc Sherman l(b)(6) l@gmail.com] Sent: Wednesday , March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled. I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper , why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost , better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes. 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best VA-18-0298-I-000436 Pag e 1051 of 2~\i of 1380 Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn, Scott R. wrote: No problem Marc. Thanks for all your help. Very helpful call last night. ~gmail.com] From: Marc Sherman l(b)(G) Sent: Wednesday , March 21 , 2018 12:12 AM To : Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am. I assume you have the calenda r invite , but just in case it isl(b)(G) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott VA-18-0298-I-000437 Page 1052 of 2~\~ of 1380 Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000438 Page 1053 of 2i~~ of 1380 Document ID: 0.7.1705.1775622 Blackburn, Scott R. Zenooz, Ashwini ; Short , John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] Re: VA EHR Date: Fri Mar 23 2018 12:16:15 EDT Attachments: I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday, March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today 's standard system functionality. At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions , standards and a clear expression of this required , defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is VA-18-0298-I-000439 Page 1054 of 2i 3~of 1380 expected so that today it can confirm its agreement to provide the full funct ional ity desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contracto r. I wou ld be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables, the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformat ion of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failu res in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quick ly, as much as anyone , but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephan ie. Each have been so generous with their time - Stephan ie will host us for a visit on Apr il 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highl ights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the spec ific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our AP I gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). VA-18-0298-I-000440 Page 1055 of 2i 4~of 1380 o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions . After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is -5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week) . We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change VA-18-0298-I-000441 Pag e 1056 of 2i ~ of 1380 4 management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns, and your comments, the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperability will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . Scott From: Marc Sherman [mailto:mbsherman@gmail.com] Sent: Wednesday, March 21, 2018 9:31 AM To : Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling. Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost , better healthcare delivery , etc. Then, with the standard fully defined and set in the original VA-18-0298-I-000442 Pag e 1057 of 2i 4~of 1380 PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that wi ll be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after cost ly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong , it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seem ingly caused by a user (clinician) revolt over inad equacy (or unsuitability) for their needs. The VA runs that same risk . Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractua lly prevent similar mistakes . 3.1have other thoughts as well that we shou ld discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. From: Marc Sherman [mailto:mbsherman@gmail.com] Sent: Wednesday , March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I canno t move. I will catch up with you or Bruce after. Marc Marc Sherman VA-18-0298-I-000443 4~of 1380 Page 1058 of 2~ (202) 758-8700 On Tue, Mar 20 , 2018, 10:30 PM Blackburn , Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite , but just in case it is l(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge , Office of Informat ion & Technology US Department of Veterans Affair s VA-18-0298-I-000444 Pa ge 1059 of 2~\i of 1380 Document ID: 0.7.1705.512143 From: Blackburn , Scott R. To: Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: Subject: FW: [EXTERNAL] Re: VA EHR Date: Fri Mar 23 2018 12:16:15 EDT Attachments: I already sent to Windom and DepSec . I told Windom to get with the Secretary today to gauge his reactions. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required, defined enhanced VA-18-0298-I-000445 Page 1060 of 2i 4~of 1380 (non-standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor . I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included, which are enhancements of today's standard deliverables, the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However , when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conf lict. I am sorry to be so harsh in my opinions, but the experts are so united on this point ; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone, but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time . Just my opinion and food for thought as you make your decis ions. Marc On Wed, Mar 21, 2018 at 10: 19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are VA-18-0298-I-000446 Page 1061 of 2i 4~of 1380 doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date . If VNDoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie 's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggest ion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA. .. something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand" . Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom VA-18-0298-I-000447 Pa ge 1062 of 2i ~ of 1380 4 talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you've read in the papers). We are paying very close attention to their implementa tion issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinc tly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior indu stry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will great ly mitigate cost, schedu le and performance concerns, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperabi lity remains at the forefront or our concerns, and your comments, the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperabi lity will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to , as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott @gmail.com] From: Marc Sherman l(b)(6) Sent: Wednesday , March 21, 2018 9:31 AM To: Blackburn , Scott R. Cc: DJS Subject: Re: [EXTERNA L] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting speci fic definitions and standards on the mean ing and use of "interoperability," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a simi lar problem (a seemingly big problem) tha t the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC , it will be very difficult and VA-18-0298-I-000448 Page 1063 of 2~\i of 1380 very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc . Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA, the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction . 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk . Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the ve ry system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc . Thanks for all your help. Very helpful call last night. @gmail.com] From: Marc Sherma ~(b)(6) Sent: Wednesday, March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. VA-18-0298-I-000449 Pag e 1064 of 2~\i of 1380 Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuab le. We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite, but just in case it is J(b)(G) I We have been unable to schedule anything with Dr. Ko (very busy calendar). We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000450 Page 1065 of 2~Y6 of 1380 Document ID: 0.7.1705.1775621 Blackburn , Scott R. Windom, John H. ; Bowman , Thomas Cc: Bee: Subject: FW : [EXTERNAL] Re : VA EHR Date: Fri Mar 23 2018 12:14 :49 EDT Attachments: John - you might want to swing the by Secretary/Deputy 's office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good .com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn , Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott , Thanks for invit ing me to listen in on your calls this week with the subject matter expert s. I was happy to make time to participate as reque sted and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans ' healthcare. However, there were severa l major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved , but indeed are not according to the experts . These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions , standards and a clear expression of this required , defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitiona l clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lack ing specificity into a VA-18-0298-I-000451 Page 1066 of 2i 5~of 1380 vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables, the contract language is ambiguous. You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe . However , when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flare s going off. Scott, I want to see this project get started, and quickly , as much as anyone, but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn , Scott R. wrote : Marc/ Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). VA-18-0298-I-000452 Pa ge 1067 of 2i 5~of 1380 o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks. Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA. ..something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand". Marc makes a great point below on turning DoD's struggles into a positive. We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the VA-18-0298-I-000453 Page 1068 of 2~ 5~of 1380 papers) . We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . This will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors. " I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc .) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care . Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc , thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate . We look forward to continuing this relationship as we take the next steps. Scott ~gmail.com] From: Marc Sherman l(b)(6 ) Sent: Wednesday , March 21 , 2018 9:31 AM To: Blackburn , Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less VA-18-0298-I-000454 Page 1069 of 2~Ya of 1380 overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA, the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction . 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote : No problem Marc. Thanks for all your help. Very helpful call last night. @gmail.com] From: Marc Sherma ~(b)(6) Sent: Wednesday , March 21, 2018 12:12 AM To : Blackburn, Scott R. Subject: [EXTERNA L] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc VA-18-0298-I-000455 Page 1070 of 2~Ys of 1380 Marc Sherman (202) 758-8700 On Tue , Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote: Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am. just in case it isl(b)(6) I I assume you have the calendar invite , but We have been unable to schedule anything with Dr. Ko (very busy calendar). We wi ll trying. Scott Scott Blackburn Executive in Charge, Office of Informat ion & Technology US Department of Veterans Affairs VA-18-0298-I-000456 Page 1071 of 2~~ of 1380 Document ID: 0.7.1705.512140 From: Blackburn , Scott R. To: Windom, John H. ; Bowman , Thomas Cc: Bee: Subject: FW: [EXTERNAL] Re: VA EHR Date: Fri Mar 23 2018 12:14:49 EDT Attachments: 18 John - you might want to swing the by Secretary/Deputy 's office before end of day to get a sense of where he is with respect to this. Sent with Good (www.good.com) From: Marc Sherman Sent: Friday , March 23, 2018 9:47:39 AM To: Blackburn, Scott R. Cc: Bruce Moskowitz ; DJS Subject: [EXTERNAL] Re: VA EHR Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts. You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality. At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required, defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of VA-18-0298-I-000457 Page 1072 of 2i 5~of 1380 definitional clarity in the contract is an invitation to ambiguity, disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity. Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient for the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example , urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables, the contract language is ambiguous. You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quick ly, as much as anyone , but with the clarity that equally serves the VA and the Contractor , and prevents evident problems down the road. I also believe these things are easy to resolve in the contract language in relatively minimal time. Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts . This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1 .1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions VA-18-0298-I-000458 Page 1073 of 2i 5~of 1380 signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo), Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contra ct documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys, infrastructure readiness, data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., VA-18-0298-I-000459 Pa ge 1074 of 2i 5~of 1380 data migration was a big issue with Congressman Phil Roe and we add ressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers). We are paying very close attention to their implementation issues (workf low, change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more). Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors ." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will great ly mitigate cost , schedu le and performance concerns , as well as support the timely injection of technological advancements (e .g. cloud, APls, etc .) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperabi lity remains at the forefront or our concerns , and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and correspond ing requ irements . Interoperabi lity will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract 's life without incurring the exorb itant costs you have alluded to , as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . Scott ~gmail.com] From: Marc Sherman l(b)(G) Sent: Wednesday, March 21 , 2018 9 :31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many mean ings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a simi lar prob lem (a seemingly big problem) that the DOD imp lementation faces now where the users are rebe lling . Unfortunate ly, if this "gap" in definition is not discovered until IOC , it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions VA-18-0298-I-000460 Page 1075 of 2~1iof 1380 and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better , eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA, the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss , but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM, Blackburn, Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. l@gmail.com] From: Marc Sherman l(b)(S) Sent: Wednesday , March 21 , 2018 12:12 AM To : Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. VA-18-0298-I-000461 Page 1076 of 2~1~ of 1380 Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we ta lked to ton ight. It was extremely va luab le. We have Stan Huff from lnte rmounta in tomo rrow at 10am . I assume you have the calendar invite , but just in case it isl(b)(6) I We have been unable to schedule anything with Dr. Ko (ve ry busy ca lendar) . We wi ll try ing. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affai rs VA-18-0298-I-000462 Page 1077 of 2~1~ of 1380 Document ID: 0.7.1705.826394 Marc Sherman From: Blackburn, Scott R. Bruce Moskowitz Cc: l(b)( 6 ) @mac .com>; DJS Bee: Subject: [EXTERNAL] Re: VA EHR Date: Fri Mar 23 2018 09:47:39 EDT Attachments: Scott, Thanks for inviting me to listen in on your calls this week with the subject matter experts. I was happy to make time to participate as requested and always happy to provide my thoughts for your consideration when requested. I read carefully your email about the efforts to work out the holes raised by the experts . You are on the way to kicking off an exciting project with a highly respected Contractor/vendor and a VA team that has worked very hard ; and I know everyone has the goal to build the best next generation system for the veterans' healthcare. However, there were several major issues raised in the calls this week with the technical and clinical experts that you try to explain away in your email as solved, but indeed are not according to the experts. These issues, they believe, will prevent a successful implementation and I fear come back to haunt this project and its overseers. I hate to be a naysayer , but I respectfully don't agree with some of your conclusions expressed in your email when I listen to the experts with whom you consulted; and the experts are in fact not swayed by the follow-up conversations with them . The experts are recommending a system for the VA that has various enhancements to today's standard system functionality . At a minimum , I heard those experts express their opinions that the contract dangerously lacks definitions, standards and a clear expression of this required, defined enhanced (non -standard) functionality (they articulate it much better than I). Failing to express this type of definitional clarity in the contract is an invitation to ambiguity , disputes and ultimate failure of purpose . The best "oversight and management of the contract" will not turn a contract lacking specificity into a vision of clarity . Including contractual clarity allows the Contractor to understand TODAY what is expected so that today it can confirm its agreement to provide the full functionality desired and have a better understanding of what is expected of them. Clarity in the contract is a healthy ingredient fo r the VA and the Contractor. I would be delighted to be wrong and welcome a demonstration of where Section 5.1 of the contract provides this specificity that Ors. Cooper and Huff, for example, urged. In light of the system requirements that these experts say must be included , which are enhancements of today's standard deliverables , the contract language is ambiguous . You say that "risk cannot be 100% driven out of any transformation of this magnitude," a concept to which I subscribe. However, when you substitute this concept for clear, written and defined functionality , especially for a design that is expected to be unique in many respects, you are doomed to disappointment and conflict. I am sorry to be so harsh in my opinions, but the experts are so united on this point ; and together with my historical observations of failures in nearly identical situations I just see warning flares going off. Scott, I want to see this project get started, and quickly , as much as anyone, but with the clarity that equally serves the VA and the Contractor, and prevents evident problems down the road . I also believe these things are easy to resolve in the contract language in relatively minimal time . VA-18-0298-I-000463 Page 1078 of 2~1~ of 1380 Just my opinion and food for thought as you make your decisions. Marc On Wed, Mar 21, 2018 at 10:19 PM, Blackburn, Scott R. wrote : Marc I Bruce , Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: ********* In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper , Dr. Karson , Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephan ie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo . o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. ******** * Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey . Obviously we will want Stephanie , John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. VA-18-0298-I-000464 Page 1079 of 2ie~of 1380 ********* As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . ********* Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross -walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. ******* ** After discussing this with Secretary Shulkin today , we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we abso lutely do not antic ipate any push back; and Gerner has promised to turn things around immediately) and wi ll move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we wi ll then have the funding and authority to do so - and Secretary Shu lkin cou ld sign as early as next week . If the Omnibus falls through (which let's hope not) , then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders wi ll allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". ********* Marc makes a great point below on turning DoD 's struggles into a positive. We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week) . We have incorporated a lot of their stumbles into our contract (e.g. , data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice. DoD's biggest prob lems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . This will make getting move on change management in Task Order #1 so important. ********* As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors. " I think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will great ly mitigate cost, schedu le and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls , etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care . VA-18-0298-I-000465 Page 1080 of 2ie~of 1380 Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperabi lity will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott @gmail.com] From: Marc Sherman l(b)(6) Sent: Wednesday , March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later, perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem) . I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare del iver y , etc. Then, with the standard fully defined and set in the origina l PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the ca ll last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent amb iguity ? Dr. Shulkin pushed back on Dr. Cooper's view as already accomp lished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction . 2.1 was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk . Perhaps that problem cou ld be a benefit to your effort . Why not accumulate all of the user VA-18-0298-I-000466 Page 1081 of 2~1iof 1380 complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today . Best Marc On Wed, Mar 21, 2018 at 8:24 AM, Blackburn , Scott R. wrote: No problem Marc. Thanks for all your help. Very helpful call last night. @gmail.com] From: Marc Sherman l(b)(6) Sent: Wednesday, March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue , Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite , but just in case it is l(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar ). We will trying. VA-18-0298-I-000467 Page 1082 of 2~1~ of 1380 Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000468 Page 1083 of 2i 8~of 1380 Document ID: 0.7.1705.512031 Blackburn , Scott R. Zenooz, Ashwini To: Windom , John H. Cc: ; Short, John (VACO) Bee: RE: Stan Huff Followup: FHIR term server Subject: Thu Mar 22 2018 10:56:27 EDT Date: Attachments: Awesome. Feel free to circle back with Stan just like you did the others. Good practice. Need these guys on our side for the long game. Life is easier when the back whispers are positive. No response yet from Bruce or Marc on my email. But I'm guessing they or Ike have already called the Secretary. Let me know if you hear anything. I also connected with Camilo yesterday. He told me call was good and he really didn't have strong feelings either way. As Tom Petty said, "the waiting is the hardest part" Sent with Good (www.good.com) From: Zenooz, Ashwini Sent: Thursday, March 22, 201810:31:11 AM To: Blackburn , Scott R. Cc: Windom, John H.; Short, John (VACO) Subject: Stan Huff Followup : FHIR term server Scott, I followed up with Cerner on Stan Huff's concern on Cerner not hosting a FHIR term server. As you can see from note below, Cerner has already been discussing hosting one themselves, independent of our discussions with them. Thank you, Ash VA-18-0298-I-000469 Page 1084 of 2ie~of 1380 Sent with Good (www.good .com) From: Waltman.David Sent: Thursday, March 22, 2018 7:19: 15 AM To: Zenooz, Ashwini Cc: Dalton .Travis ; Syed .Jenni ; McCallie,David; Obenhaus ,Matt; Qadri,Mustafa Subject: [EXTERNA L] FHIR term server Ash - you had asked yesterday about whether Gerner hosts a FHIR term server. Today we can return FHIR resources via the appropriate APls, but we don 't current ly have a term server permitting lookups. This is something we have been discuss ing, and while we believe it is advantageous for a term server to be hosted by outside collaborative organizations, we realize there may be a need at this evolutionary stage of the standard to host one ourselves. If beneficial to the effort, we are certainly open to doing so. Please let me know if you would like to discuss further. Thanks! David David Waltman Gerner Corporation V ice President , Federa l Strategy and Techno logy !(b)(6) @cerner .com 425-418 - 1615 CONFIDENT IALITY NOT ICE This message and any included attachments are from Gerner Corporation and are intended only for the addressee. The information contained in this message is confidentia l and may constitute inside or non-public information under international, federa l, or state securi ties laws . Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please prompt ly delete this message and notify the sender of the delivery error by e-mai l or you may call Cerner's corporate offices in Kansas City, Missouri, U.S.A at (+1) (816)221-1024. VA-18-0298-I-000470 Page 1085 of 2~WJ of 1380 Document ID: 0.7.1705.511414 From: Blackburn , Scott R. To: DJS Cc: Bee: Subject: RE: VA EHR Date: Wed Mar 21 2018 23:22:21 EDT Attachments: Hopefully in a good way From: DJS Sent: Wednesday, March 21, 2018 10:26 PM To: Blackburn, Scott R. Subject: RE: VA EHR Wow that's quite an email Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 7:20:26 PM To:DJS Subject: FW: VA EHR Hopefully this lands well. Let me know what you hear back. From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 10:20 PM To: 'Bruce Moskowitz'; 'Marc Sherman' Cc: DJS Subject: VA EHR Marc I Bruce , VA-18-0298-I-000471 Page 1086 of 2i 7~of 1380 Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VNDoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could VA-18-0298-I-000472 Pag e 1087 of 2i 7~of 1380 sign as early as next week . If the Omnibus falls through (which let's hope not} , then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA ... something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand". Marc makes a great point below on turning DoD 's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g. , data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors ." I think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract , and more importantly the proper oversight and management of the contract will greatly mitigate cost , schedule and performance concerns , as well as support the timely injection of technological advancements (e.g . cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care . Interoperability remains at the forefront or our concerns , and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps . Scott l@gmail.com] From: Marc Sherman l(b)(6 ) Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS VA-18-0298-I-000473 Page 1088 of 2~'% of 1380 Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definit ion is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better , eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fa irness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contra ct language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn, Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. VA-18-0298-I-000474 Pag e 1089 of 2i 7~of 1380 From: Marc Sherman !(b)(6) @gmail.com] Sent: Wednesday, March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue , Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite , but just in case it is l(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000475 Page 1090 of 2~W; of 1380 Document ID: 0.7.1705.511412 From: DJS To: Blackburn, Scott R. Cc: Bee: Subject: RE: VA EHR Date: Wed Mar 21 2018 22:25:48 EDT Attachments: Wow that's quite an email Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 7:20:26 PM To:DJS Subject: FW: VA EHR Hopefully this lands well. Let me know what you hear back. From: Blackburn , Scott R. Sent: Wednesday, March 21, 2018 10:20 PM To: 'Bruce Moskowitz'; 'Marc Sherman' Cc: DJS Subject: VA EHR Marc/ Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead. A few notes: In order to make sure we understand some of the more specific detailed points , members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April VA-18-0298-I-000476 Page 1092 of 2i 7~of 1380 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Cerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John, Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts . Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback , we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand". VA-18-0298-I-000477 Pa ge 1093 of 2i 7~of 1380 Marc makes a great point below on turning DoD's struggles into a positive. We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce 's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors. " I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls , etc .) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care . Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners " on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott @gmail.com] From: Marc Sherman l(b)(6) Sent: Wednesday , March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled. I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry VA-18-0298-I-000478 Page 1094 of 2~1/s of 1380 as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong , it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today . Best Marc On Wed, Mar 21, 2018 at 8:24 AM, Blackburn , Scott R. wrote: No problem Marc. Thanks for all your help. Very helpful call last night. From: Marc Sherman l(b)(6) @gmail.com] Sent: Wednesday , March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott VA-18-0298-I-000479 Page 1095 of 2~'% of 1380 I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am. just in case it is l(b)( 6 ) I I assume you have the calendar invite , but We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000480 Page 1096 of 2~1iof 1380 Document ID: 0.7.1705.511403 Blackburn , Scott R. Windom, John H. Cc: Bee: Subject: FW: VA EHR Date: Wed Mar 21 2018 22:20:46 EDT Attachments: Let's hope this lands well ... From: Blackburn, Scott R. Sent: Wednesday , March 21 , 2018 10:20 PM To: 'Bruce Moskowitz'; 'Marc Sherman' Cc: DJS Subject: VA EHR Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable . Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highlights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners) . o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Gerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VNDoD/lntermountain work together we w ill quickly get to the 200 number Stan mentioned. VA-18-0298-I-000481 Page 1097 of 2i 8~of 1380 Per Stephanie's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis . Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo), Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Gerner ASAP (we absolutely do not anticipate any push back; and Gerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take -2 weeks . Signing the initial task orders will allow us to start moving forward with Gerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys, infrastructure readiness, data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is -5% of the value of the contract). But this will allow us to get moving and out of the "quicksand" . Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management, governance) to make sure we don't make the same mistake twice. DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn 't agree more) . Th is will make getting move on change management in Task Order #1 so important. VA-18-0298-I-000482 Page 1098 of 2~ 8~of 1380 As you both know, risk cannot be 100% driven out of any transformation of this magnitude. Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors." I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again, we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperabil ity remains at the forefront or our concerns, and your comments, the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperab ility will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently, you have been tremendous "demand ing partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott From: Marc Sherman l(b)(G) @gmail.com] Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled. I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperabil ity," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling. Unfortunately, if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design, happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time, allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fa irness to them, the VA, the patients and healthcare, so they can proceed with that standard from day one or express any concerns VA-18-0298-I-000483 Page 1099 of 2~1~ of 1380 they may have now instead of in the future after cost ly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulk in pushed back on Dr. Cooper's v iew as already accomp lished in the PWS and cited Sect ion 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defin ing language to set out unambiguous definit ions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it wou ld be usefu l for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementat ion seem ingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that prob lem cou ld be a benefit to your effort. Why not accumulate all of the user compla ints/ issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA imp lementation and include them in the contract as definitiona l requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we shou ld discuss, but these are the ones that I felt more pressing to high light since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote : No problem Marc . Thanks for all your help. Very helpful call last night. @gmail.com] From: Marc Sherman l(b)(G) Sent: Wednesday , March 21 , 2018 12:12 AM To: Blackburn , Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn , Scott R. wrote : VA-18-0298-I-000484 Page 1100 of 2~1iof 1380 Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am. I assume you have the calendar invite , but just in case it is l(b)(G) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000485 Page 1101 of 2~1~ of 1380 Document ID: 0.7.1705.511402 From: Blackburn, Scott R. To: DJS Cc: Bee: Subject: FW: VA EHR Date: Wed Mar 21 2018 22:20:26 EDT Attachments: Hopefully this lands well. Let me know what you hear back. From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 10:20 PM To: 'Bruce Moskowitz'; 'Marc Sherman' Cc: DJS Subject: VA EHR Marc I Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha, Jon Manis and Stephanie . Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc highl ights below to make sure we are on the same page and have the language right (part was us better understanding his point; part was pointing him to the specific language in 5.1.1 and giving him the broader context with what we are doing with Lighthouse as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Gerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lntermountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/ lntermountain work together we will quickly get to the 200 number Stan mentioned. VA-18-0298-I-000486 Page 1102 of 2i 8~of 1380 Per Stephanie's suggestion , we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formalizing this will allow for continuity of expertise throughout our journey. Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include. We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our Initia l Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through (which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take ~2 weeks. Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA. .. something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon). As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much ; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers). We are paying very close attention to their implementation issues (workf low, change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . Th is will make getting move on change management in Task Order #1 so important. VA-18-0298-I-000487 Page 1103 of 2i 8~of 1380 As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors." I think we have a great plan . The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc .) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care . Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come , but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently , you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott From: Marc Sherman [mailto:mbsherman@gmail.com] Sent: Wednesday , March 21 , 2018 9:31 AM To : Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nightt ime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to prov ide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want VA-18-0298-I-000488 Pa ge 1104 of 2i 8~of 1380 to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others , but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed , Mar 21 , 2018 at 8:24 AM , Blackburn , Scott R. wrote : No problem Marc. Thanks for all your help . Very helpful call last night. From: Marc Sherma rl(b)(G) l§gmail.com] Sent: Wednesday , March 21, 2018 12:12 AM To : Blackburn , Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely VA-18-0298-I-000489 Page 1105 of 2~1iof 1380 valuable. We have Stan Huff from lntermountain tomorrow at 10am. I assume you have the calendar invite , but just in case it is l(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying . Scott Scott Blackburn Executive in Charge, Office of Informat ion & Technology US Department of Veterans Affairs VA-18-0298-I-000490 Page 1106 of 2~1iof 1380 Document ID: 0.7.1705.511400 From: Blackburn, Scott R. To: Bruce Moskowitz !(b)(G) @mac .com>; Marc Sherman .... l(b_)(_G)__ DJS Bee: VA EHR Subject: Wed Mar 21 2018 22:19:56 EDT Date: Attachments: ___, l@gmail.com> Marc/ Bruce, Thank you once again for all your support and especially for linking us up with these CIOs/experts. This was incredibly valuable. Secretary Shulkin, John Windom and I got together earlier today as well to talk about the path ahead . A few notes: In order to make sure we understand some of the more specific detailed points, members of our team reached out today for individual follow ups with Dr. Cooper, Dr. Karson, Dr. Shrestha , Jon Manis and Stephanie. Each have been so generous with their time - Stephanie will host us for a visit on April 4 and Dr. Cooper offered to do the same at Mayo. o Dr. Zenooz did connect with Dr. Cooper today on the point Marc high lights below to make sure we are on the same page and have the langu age right (part was us better understanding his point; part was pointing him to the spec ific language in 5.1.1 and giving him the broader context with what we are doing with Lighthou se as our API gateway and the VA Open API Pledge that 11 healthcare institutions signed two weeks ago include Cris Ross at Mayo as well Stan Huff at lntermountain and Dr. Karson at Partners). o We will also follow up with Stan on some of the issues he raised as well. For example: Stan will be excited to learn that Gerner has prioritized an additional 40 engineers to accelerate FHIR APls for VA in support of this contract. This will also benefit lnterm ountain as Stan was telling us they 've only had 1015 for their entire company to date. If VA/DoD/lntermountain work together we will quickly get to the 200 number Stan mentioned. Per Stephanie 's suggestion, we are going to start moving forward ASAP on formalizing an Advisory Committee so that we can get these insights on an ongoing basis. Formaliz ing this will allow for cont inuity of expertise throughout our journey . Obviously we will want Stephanie, John , Andy, Rasu, etc. Cris Ross (Mayo) , Will Morris or Ed Marx (Cleveland Clinic), Frank Opelka (American College of Surgeons) are others you've introduced us to along the way that we would love to include . We would like to work with you to make sure we get this right. As recommended last night, an interoperability sandbox/test bed will be established during our VA-18-0298-I-000491 Page 1107 of 2~1~ of 1380 Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is a great suggestion and very consistent with what we have been hearing from many experts. Our team is reviewing all the feedback (both oral from the calls and the written notes that some provided) and cross-walking this against the language in the RFP/contract documents (both EHR and also Lighthouse). We are not seeing any major changes to the contract nor do we see any showstoppers. Upon receiving the feedback, we feel very good that we have a solid contract from which we will just need to make minor revisions. After discussing this with Secretary Shulkin today, we feel strongly about moving forward quickly. We will make any necessary tweaks with Cerner ASAP (we absolutely do not anticipate any push back; and Cerner has promised to turn things around immediately) and will move forward to sign the overarching IDIQ contract. Assuming Congress approves the Omnibus bill by Friday (and President Trumps signs it), we will then have the funding and authority to do so - and Secretary Shulkin could sign as early as next week . If the Omnibus falls through {which let's hope not), then we would have to request a transfer from the Congressional appropriation committees which will then take -2 weeks . Signing the initial task orders will allow us to start moving forward with Cerner on the initial 3 hospitals (which will be in Washington state) on things like site surveys , infrastructure readiness , data hosting, change management (with will include wide involvement from clinicians inside and outside VA .. .something we heard loud and clear from Bruce!), help desk establishment , and project oversight (which we've heard loud and clear from Stephanie/Jon) . As a reminder , given the IDIQ structure of the contract we would not be signing the full contract (rather just Year 1 - which is ~5% of the value of the contract). But this will allow us to get moving and out of the "quicksand ". Marc makes a great point below on turning DoD's struggles into a positive . We have been working very closely with the DoD team over the past 9 months (I now have my own Pentagon ID pass I am there so much; John and I work very closely with their EHR lead Stacy Cummings ; John Windom talks to her several times a week). We have incorporated a lot of their stumbles into our contract (e.g., data migration was a big issue with Congressman Phil Roe and we addressed that; and most recently we have made some adjustments on trouble ticket management based on what you 've read in the papers) . We are paying very close attention to their implementation issues (workflow, change management , governance) to make sure we don't make the same mistake twice . DoD's biggest problems are around implementation and change management. This underscores Bruce's point of making sure we have clinician buy-in and involvement from the get-go (I couldn't agree more) . Th is will make getting move on change management in Task Order #1 so important. As you both know, risk cannot be 100% driven out of any transformation of this magnitude . Stephanie Reel so succinctly captured , "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors. " I think we have a great plan. The biggest thing I worry about will be executing and we are definitely going to need all the help we can get. Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care. Interoperability remains at the forefront or our concerns , and your comments , the MITRE study and VA-18-0298-I-000492 Pag e 1108 of 2i 9~of 1380 various other external inputs contributing significantly to our RFP language and corresponding requirements. Interoperability will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . Bruce/Marc, thank you for everything. As I mentioned to Bruce recently, you have been tremendous "demanding partners" on this journey and we are incredibly appreciate. We look forward to continuing this relationship as we take the next steps. Scott @gmail.com] From: Marc Sherma 1(b)(S) Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard. That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling. Unfortunately , if this "gap" in definition is not discovered until IOC , it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk . Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify VA-18-0298-I-000493 Page 1109 of 2~1~ of 1380 which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn, Scott R. wrote: No problem Marc . Thanks for all your help. Very helpful call last night. From: Marc Sherman l(b)(G) @gmail.com] Sent: Wednesday , March 21 , 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am. just in case it is j(b)(6) I I assume you have the calendar invite , but We have been unable to schedule anything with Dr. Ko (very busy calendar ). We will trying. VA-18-0298-I-000494 Page 1110 of 2~1iof 1380 Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000495 Page 1111 of 2i 9~of 1380 Document ID: 0.7.1705.510823 Blackburn, Scott R. Windom, John H. Cc: Bee: Subject: RE: [EXTERNAL] Re: Stan Huff Date: Wed Mar 21 2018 18:08:45 EDT Attachments: , Thanks. I appreciate this . Hope my note lands well with them . Fingers crossed . This has been a heck of a journey. of a team. I'm proud to have been in the foxhole with you. We 've made a heck From: Windom, John H. Sent: Wednesday , March 21 , 2018 3:44 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] Re: Stan Huff Here you go Sir: Marc , Many thanks for the follow-up note this morning and your expert thoughts and orchestration of the inputs from a myriad of industry subject matter exerts over the past weeks in support of VA's EHR Modernization efforts. We are leveraging these expert thoughts and comments to review/refine/revalidate our RFPs (EHR and DVP), strategy/management documents and risk management portfolios as appropriate. We have been coordinating our efforts over the past 9 months with DoD and routinely exchanging lessons learned to ensure our overall contract and oversight strategies further mitigates their challenges and/or concerns. This can readily be seen in a myriad of updates to our contract, most recently trouble ticket management. As you know , risk cannot be 100% driven out of any endeavor of this magnitude or importance thus as Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA 'S access to senior industry advisors. " As such, at the Secretary 's direction we will be forming a senior advisory to assist us throughout the process. We hope that you and Bruce will want to continue to advise and monitor us on our efforts, both near and long term. Some of our preliminary thoughts of membersh ip include the following and would welcome your thoughts on the makeup of this critical advisory group: Stephanie Reel (Hopkins) Jon Manis (Sutter) VA-18-0298-I-000496 Page 1112 of 2i 9~of 1380 Rasu (UPMC) Shafiq Rab (Rush) Chris Ross (Mayo) Vivek Reddy (lntermountain) Aneesh Chopra Ryan Howells (Leavitt Partners) Frank Opelka (American College of Physicians) Will Morris or Ed Marx (Cleveland Clinic) Dr. Andy Karson (Mass General Hospital) Dr. Bruce Moskowitz (Tenet) Alistair Erskine (Geisinger) Daniel Barchi (New York Presbyterian) Again, we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedu le and performance concerns, as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care pledge . Interoperabi lity remains at the forefront or our concerns, and your comments, the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . As recommended , an interoperability sandbox/test bed will be estab lished during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is consistent with the desires of many of our external experts. Change management , governance , training and communication remain critical and foundational elements of business transformation success. The program management office (PMO) will be the primary orchestrator of these strategies but will be calling for support from the entire VA enterprise to implement these practices in support of EHR modernization objectives . Marc, thank you for everything. our offer to be an advisor . We are ready to take the next step. We hope you will take us up on Scott I thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperabili ty," especially since that term has as many meanings in the industry VA-18-0298-I-000497 Pag e 1113 of 2i 9~of 1380 as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning. The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong , it would be useful for someone to point me in the right direction. 1.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements . You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes. 2.1have other thoughts as well that we should discuss , but these are the ones that I felt more pressing to highlight since I will be unavailable today . Best 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 VA-18-0298-I-000498 Pa ge 1114 of 2i 9~of 1380 Mobile : l~ (b_)(G _) ___ ~ Executive Assistant: Ms . .... l(b_)(_G)__ l~ (b_ )(6_) -~ _,~Appointments and Scheduling ~va .gov Office : 202-382-3792 From: Blackburn, Scott R. Sent: Wednesday , March 21, 2018 9:35 AM To: Windom, John H. Subject: FW: [EXTERNAL] Re: Stan Huff From: Marc Sherman l(b)(6) @gmail.com] Sent: Wednesday, March 21, 2018 9:31 AM To : Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperabili ty ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seem ingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunate ly , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better , eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that wi ll be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the VA-18-0298-I-000499 Page 1115 of 2~1iof 1380 patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS . Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 3.1have other thoughts as well that we should discuss , but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM , Blackburn , Scott R. wrote: No problem Marc. Thanks for all your help . Very helpful call last night. l@gmail.com] From: Marc Sherma ~(b)(G) Sent: Wednesday , March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue, Mar 20 , 2018, 10:30 PM Blackburn , Scott R. wrote : VA-18-0298-I-000500 Page 1116 of 2ibiof 1380 Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am. I assume you have the calenda r invite , but just in case it is l(b)( 6 ) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott Scott Blackburn Executive in Charge, Office of Informat ion & Technology US Department of Veterans Affairs VA-18-0298-I-000501 Page 1117 of 2ib~of 1380 Document ID: 0.7.1705.1541092 Windom, John H. Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL ] Re: Stan Huff Date: Wed Mar 21 2018 15:44:28 EDT Attachments: Here you go Sir: Marc, Many thanks for the follow-up note this morning and your expert thoughts and orchestration of the inputs from a myriad of industry subject matter exerts over the past weeks in support of VA 's EHR Modernization efforts . We are leveraging these expert thoughts and comments to review/refine/revalidate our RFPs (EHR and DVP), strategy/management documents and risk management portfolios as appropriate. We have been coord inating our efforts over the past 9 months with DoD and routinely exchanging lessons learned to ensure our overall contract and oversight strategies further mitigates their cha llenges and/or concerns. This can readily be seen in a myriad of updates to our contract, most recently trouble ticket management. As you know , risk cannot be 100% driven out of any endeavor of this magnitude or importance thus as Stephanie Reel so succinctly captured, "it is the oversight and management of the contract that will be of the utmost importance, as well as the VA'S access to senior industry advisors." As such, at the Secretary's direction we will be forming a senior advisory to assist us throughout the process . We hope that you and Bruce will want to cont inue to adv ise and monitor us on our efforts, both near and long term. Some of our preliminary thoughts of membersh ip include the follow ing and would welcome your thoughts on the makeup of this critical adv isory group: Stephanie Reel (Hopkins) Jon Manis (Sutter) Rasu (UPMC) Shafiq Rab (Rush) Chris Ross (Mayo) Vivek Reddy (lntermountain) Aneesh Chopra Ryan Howells (Leavitt Partners) Frank Opelka (American College of Physicians) Will Morris or Ed Marx (Cleveland Clinic) VA-18-0298-I-000502 Page 1118 of 2 50~of 1380 Dr. Andy Karson (Mass General Hospital) Dr. Bruce Moskowitz (Tenet) Alistair Erskine (Geisinger) Daniel Barchi (New York Presbyterian) Again , we believe the construct of the contract, and more importantly the proper oversight and management of the contract will greatly mitigate cost, schedule and performance concerns , as well as support the timely injection of technological advancements (e.g. cloud, APls, etc.) at the appropriate pace and balance necessary to support our Veterans without jeopardizing our overall care pledge . Interoperability remains at the forefront or our concerns, and your comments , the MITRE study and various other external inputs contributing significantly to our RFP language and corresponding requirements . Interoperability will be a moving target for years to come, but our contract allows us to leverage the best of ideas of industry throughout the contract's life without incurring the exorbitant costs you have alluded to, as well as not be bound by potentially antiquated definitions . As recommended , an interoperability sandbox/test bed will be established during our Initial Operating Capabilities (IOC) implementation/deployment process to solidify the requisite interoperability requirements prior to full enterprise deployment. This is consistent with the desires of many of our external experts. Change management, governance , training and communication remain critical and foundational elements of business transformation success. The program management office (PMO) will be the primary orchestrator of these strategies but will be calling for support from the entire VA enterprise to implement these practices in support of EHR modernization objectives . Marc, thank you for everything . We are ready to take the next step . We hope you will take us up on our offer to be an advisor . Scott I thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later, perhaps even up to implementation, a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definition is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community, less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better, eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night). Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA , the patients and healthcare, so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want VA-18-0298-I-000503 Page 1119 of 2 50~of 1380 to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician, deferred on the effectiveness of the existing contract language to others , but commented that the CIO of MAYO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 1.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs . The VA runs that same risk. Perhaps that problem could be a benefit to your effort . Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to contractually prevent similar mistakes . 2.1 have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best 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 MobileJ._ (b_)(G _)____ __, _l_~I - Appointments and Scheduling Executive Assistant: Ms.~l (b_)(6 l~ (b-)(G _)_~ ~va.gov Office : 202-382-3792 VA-18-0298-I-000504 Page 1120 of 2ibi of 1380 From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 9:35 AM To: Windom, John H. Subject: FW: [EXTERNAL] Re: Stan Huff l@gmail.com] From: Marc Sherman l(b)(G) Sent: Wednesday, March 21, 2018 9:31 AM To: Blackburn, Scott R. Cc: DJS Subject: Re: [EXTERNAL] Re: Stan Huff I agree that the call was very helpful. I spent the night after the call reflecting on some of the discussion and thought I would offer some reaction/feedback that still seems unsettled . I will outline my nighttime thoughts below in case you find them useful. 1.1thought that Dr. Cooper made a good case for inserting specific definitions and standards on the meaning and use of "interoperability ," especially since that term has as many meanings in the industry as those who speak it. It is so easy for the contractor to proceed down a design path using one definition or standard while the users will require a totally different standard . That runs the risk of not being discovered until later , perhaps even up to implementation , a very costly result. Perhaps a similar problem (a seemingly big problem) that the DOD implementation faces now where the users are rebelling . Unfortunately , if this "gap" in definit ion is not discovered until IOC, it will be very difficult and very expensive to fix (ala the DOD problem). I agree with Dr. Cooper, why not set the critical definitions and standards in the contract (PWS) now and eliminate the chance for any confusion or ambiguity. It will pay dividends later in terms of less arguments, better initial design , happier user community , less overall cost, better healthcare delivery, etc. Then, with the standard fully defined and set in the original PWS, the mock-up test will be much sooner in time and much more complete the first time , allowing the users to provide input sooner and better , eliminating costly design mistakes from the beginning . The user community can tell you today what is needed to accomplish this "next generation" system that will be a model for the country and the future of healthcare (as Ms. Reel envisioned on the call last night) . Why would you not want to tell the contractor the specifics of that now, in fairness to them, the VA. the patients and healthcare , so they can proceed with that standard from day one or express any concerns they may have now instead of in the future after costly design has occurred? Why would you not want to be specific in the contract to prevent ambiguity? Dr. Shulkin pushed back on Dr. Cooper's view as already accomplished in the PWS and cited Section 5 (I believe he said section 5.1.1) of the PWS. Dr. Cooper, as a physician user and not a technician , deferred on the effectiveness of the existing contract language to others, but commented that the CIO of MA YO read the contract and also did not think it adequately contained the right defining language to set out unambiguous definitions and standard. I have read the contract again last night and happen to agree, or am missing it. If I am wrong, it would be useful for someone to point me in the right direction. 2.1was also thinking about the current reported problems of the DOD implementation seemingly caused by a user (clinician) revolt over inadequacy (or unsuitability) for their needs. The VA runs that same risk. Perhaps that problem could be a benefit to your effort. Why not accumulate all of the user complaints/issues in the DOD implementation identified by the users and chart them out. Then identify which of those issues would be issues if they existed in the VA implementation and include them in the contract as definitional requirements. You have the benefit of knowing the failures in the very system upon which you are modeling your system ...and you have an added advantage and opportunity to VA-18-0298-I-000505 Pag e 1121 of 2ib~ of 1380 contractually prevent similar mistakes. 3.1 have other thoughts as well that we should discuss, but these are the ones that I felt more pressing to highlight since I will be unavailable today. Best Marc On Wed, Mar 21, 2018 at 8:24 AM, Blackburn, Scott R. wrote: No problem Marc . Thanks for all your help . Very helpful call last night. @gmail.com] From: Marc Sherman l(b)(G) Sent: Wednesday, March 21, 2018 12:12 AM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: Stan Huff Scott I won't be able to join the call tomorrow as I have a previous commitment that I cannot move. I will catch up with you or Bruce after. Marc Marc Sherman (202) 758-8700 On Tue , Mar 20, 2018, 10:30 PM Blackburn, Scott R. wrote : Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable . We have Stan Huff from lntermountain tomorrow at 10am. just in case it is l(b)(6) I I assume you have the calendar invite, but We have been unable to schedule anything with Dr. Ko (very busy calendar). We will trying. Scott VA-18-0298-I-000506 Page 1122 of 2ibi of 1380 Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000507 Page 1123 of 2 50~of 1380 Document ID: 0.7.1705.1539599 From: Bruce Moskowitz To: Blackburn, Scott R. 5 1pcb>c > frenchangel59.c ..,.. o ..... m"->-· --~ Cc: (b)(G) gmail.com l(b)(6) t@gmail.com>; EQ:@ frenchangel59.com (b)(6) renc angel59.com> Bee: Re: [EXTERNAL] Stan Huff Subject: Wed Mar 21 2018 13:40:21 EDT Date: Attachments: Thank you Sent from my iPad Bruce Moskowitz M.D . > On Mar 21 , 2018 , at 1:08 PM, Blackburn , Scott R. wrote: > > Figured it out. Here are the files/notes that Stan wrote up for us ... > > -----Original Message---- From: Bruce Moskowitz .-l > Sent: Wednesday , March 21 , 2018 11 :30 AM > To: Blackburn, Scott R. @gmail.com > Cc : IP:!{bl/61 > Subject: [EXTERNAL] Stan Huff > > Can you send his notes to us? Thank you > > Sent from my iPad > Bruce Moskowitz M.D. > > > VA-18-0298-I-000508 Page 1124 of 2ibi of 1380 Document ID: 0.7.1705.1539598 From: Bruce Moskowitz !(b)(G) @mac.com> To: Blackburn, Scott R. Cc: frenchangel59.c ,_ om _ >_: ---. @gmail.com>; ~ ,--~~-----. '""gmail.com l(b)(G) renc angel59.com> Bee: Subject: Re: [EXTERNAL] Stan Huff Date: Wed Mar 21 2018 13:39:55 EDT Attachments: frenchangel59 .com Thank you Sent from my iPad Bruce Moskowitz M.D. > On Mar 21, 2018 , at 1:03 PM, Blackburn , Scott R. wrote: > > Attached is what Stan sent me. I haven't been able to open it. I'm going to have to go back to him and have him resend . > > Scott > > -----Original Message--- -;= -------------. > From: Bruce Moskowitz l(b)(G) ~ma c.com] > Sent: Wednesday , Maren 21 , 20 18 I I :30 AIVI > To: Blackburn, Scott R. > Cc: IP; l(b)(G) @gmail.com > Subject: [EXTERNAL] Stan Huff > > Can you send his notes to us? Thank you > > Sent from my iPad > Bruce Moskowitz M.D. > VA-18-0298-I-000509 Page 1125 of 2ibi of 1380 Document ID: 0.7.1705.510733 From: Blackburn , Scott R. To: Windom, Jo hn H. ; Zenooz, Ashwini 6)____ 21 /cn=rec ipients/cn=v hapalzenooa>: 1.... (b_)(_ ~ ; Short, John (VACO) ; Myklegard, Drew Cc: Bee: FW: [EXTERNAL] Stan Huff Subject: Wed Mar 21 2018 13:23:35 EDT Date: Attachments: Copy of 003 - VA EHRM Non-Funct ional RTM (Amended 2.16.20 18) smh .xlsx Requests for Gerner EHR platform to Support Innovation and Interoperab ility smh.docx suggestions to VA on the contract.docx In case you guys didn't get these note from Stan Huff ... -----O riginal Message- ---From: Blackburn, Scott R. Sent: Wednesday, March 21, 2018 1:09 PM To: 'Bruce Moskowitz' J@gmai l.com Cc: IP;r )(6) Subjec : RE : [EX I RNAL] Stan Huff Figured it out. Here are the file s/no tes that Stan wrote up for us ... -----Original Message----From: Bruce Moskowitz .-l (b-)(-6)---------. Sent: Wednesday, March 21, 2018 11 :30 AM To: Blackburn, Scott R. l@gmail.com Cc: IP;!(b)(6) Subject: [EXTERNAL] Stan Huff @mac.eom] Can you send his notes to us? Thank you Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000510 Page 1126 of 2i~i of 1380 Document ID: 0.7.1705.510733-000002 Owner: Blackburn, Scott R. Filename: Requests for Gerner EHR platform to Support Innovation and Interoperability smh. docx Last Modified: Wed Mar 21 12:23:35 CDT 2018 VA-18-0298-I-000511 Page 1129 of 2 5l~ of 1380 Requests fo r Gerner EHR platform to Support Innovation and Intero perabi lity smh.docx for Printed Item: 409 ( Attachment 2 of 3) Functionality Requests for Cerner EMR platform to Support Innovation and Interoperability In order to meet the innovation need s of Intermountain Hea lthcare to be a model health system , several t ype s of enhancements to the Cerner EMR platform are needed. These enhancement type s con sist of the following: 1. Open Services (i.e., FHIRresources) a. Data Read Services b. Data Write Services c. Order Submission Services d. Select Event Publicat ion Services 2. Open Application Framework 3. Open CDSIntegration (i.e., CDSHooks) 4. Open Development Tools Additionally, a gove rnan ce structure is needed in order for Intermountain and Cerner to determine specific functionality, prioriti zation , acceptance criteria and schedu le for enhancements. The gove rnan ce stru cture would also handle chan ge requests and dispute s. These enhancement reque sts can be de scribed in more detail by applying them to severa l applications that Intermountain can dep loy or could use as demon stration s of the innovation and interoperability capabilities and/or building blocks for future innovations on the platform . Example applications include: Pulmonary Embolism (PE) Diagnosis and Treatment, Pediatri c Growth Chart, Neona ta l Bilirubin Tracking, Opioid Man ageme nt , Device Interoperability Pilot, Referral/S cheduling Management, and Health Information Exchange Data Viewer. Intermountain Health care is working closely with the University of Utah on several grant funded proje ct s to advance seve ral of the se applications. For each of the enhancement type s listed above , more detail is presented here , along with information about how th ese re late to th e example applications. Open Services Open Services refers to the open, stan dard s-ba sed service API (application pro grammin g interfa ce) on top of the Cerner EMR platform. It pro vides access from 3rd party applications and serv ices to the und erlying Cerner platform , part icularl y the data and knowledge asse t s within Cerner repo sitorie s, but also logic and services available within the Cerner platform. Intermountain an d Cerner ha ve agreed that this layer would utilize the HL7 FHIRspeci fication, at least initially. Cerner ha s mad e conside rable pro gress in implement ing a FHIRservice layer on top of its EMR, part icularl y for Data Read services to meet requirements of Meaningful Use and the Clinical Quality Framework (CQF). But additional and timelier enhancements in this area are needed. Open Services enhancements fall under th e following categories: VA-18-0298-I-000512 1 Page 1130 of 2g1~ of 1380 Requests fo r Gerner EHR platform to Suppor t Innovation and Intero perabi lity smh.docx for Printed Item: 409 ( Attachment 2 of 3) 1. FHIRResource Read Services: These Services allow a 3rd party app lication or service to access data from repo sitories within the Cerner plat.form. The Resource s also allow query capability according to the FHIRstandard, which can be enhan ced by FHIR Profiles. The quer y capability is men tioned because we have found inconsistencies in th e way that Cerner support s FHIR querie s and we would like to re solve this with them. Cemer support s qu erying and readin g most of th e more "popular" FHIRre source s under FHIRDSTU2, but spe cific data types within resources such as Observation and Document.Reference may not be fully available throu gh the interface. There are also attribut es of certain reso urces that are not returned by the services. These missing data type s and attribu tes are essential to meet th e need s of the example applications. More detail is pro vided for eac h example application. 2. FHIRResource Write Services: These Services allow a 3rd part y application or service to write data into a repo sitory within the Cerner plat.form. Cemer supports severa l Resource Write Services, but this list is far from complete to support functionalit y required by some of the example applications. More detail is provided for eac h example application. 3. Supp ort for FHIRProfiles : FHIRProfiles allow a FHIRResource to be tailored to a specific need, and can be used to specify a higher level of semantic interoperab ility for re source dat a shared betwee n FHIRresource servers and consumers (e.g., a Cerner repo sitory providing access throu gh FHIRservices, and a 3rd party applicatio n queryin g for data from the Cerner reposi tory throu gh the FHIRservices). Use of FHIRResources alone doe s not ensure true se manti c interoperability. Cerner do es provide support for the CQF FHIRProfiles, parti cularly as a re sult of participat ion in the Argonauts conso rtium , but the se profile s are at a level too high to ensure true se manti c interoperab ility, and the y do no t comple tely cover the data access nee ds of the example applications. We ha ve also found incon sisten cies in th e way that EMR vendo rs pro vide support for FHIR pro files. We would like to work with Cerner, and other EMRvendor s, to de velop mor e complete spe cification s on what it mean s to support a FHIRprofi le (poss ibly throu gh the Argonaut s consortium). We would also like to work with Cerner on specific FHIRpro files de veloped throu gh the HSPC/CIMIinitiative to support the example applications. More detail for specific FHIRpro files is pro vided for some of the exam ple applicat ions. 4. Supp ort for higher-level FHIRResources : "Higher-level FHIRResources" include functionality that goe s beyond reading and writing data to/from a repository. These higher-level functio ns typically support workflow, such as ord ering and scheduling. It also includes the ability to po st events (the "Flag" resource in FHIR). More detail for specific higher-level re sources is pro vided for some of the example app lications. 5. Migration strategy for FHIRversions: FHIRis a de veloping standard , and HL7 continues to work on new versions of th e standard. Most EMRvendors have se ttled on current supp ort for the DSTU2 version, but HL7 ha s pub lished Relea se 3. Successive versions of FHIRhave broken previou s versions. This understa ndably lea ds to some hesitat ion about fully supportin g a given release if it will be broken in a short time , and/or pot entially never will be utilized in a produ ction environment . We also have no guara ntee from an application de velopmen t perspective on if/when a vendor will support a given release , and when a previous release will become un support ed . We nee d to work with Cemer on VA-18-0298-I-000513 2 Page 1131 of 2grn of 1380 Requests fo r Gerner EHR platform to Suppor t Innovation and Intero perabi lity smh.docx for Printed Item: 409 ( Attachment 2 of 3) a strate gy for handling support and migration ofFHIRversions, and we need to come to agreement on whet her the unknown s about HL7 FHIRdevelopment should det er current use of a given relea se version. This should probably be handled by the governance structure suggested earlier. Examples of how the Open Services apply to the example application s are the following: Pulmonary Embolism (PE)Diagnosis and Treatment: The accompanying Excel file (Pulmonary Embolism Factors.xlsx) pre sent s detail s on the spe cific data type s used by the PE tool , and the corre spondin g FHIRReso urce s and FHIRProfiles required . It also show s which services need Read and/or Write functionality. Note that the Alert.Event model is still under discussion, as we are unsure what Resource would correspond with this. Pediatric Growth Chart: This applica tion need s standard Patient and Encounter Resource s, as well as the Observation Resource mapped to variou s dat a type s for Height/Leng th , Weight , Head Circumference and BMI.These are Read services toda y, but it would be helpfu l to the clinician workflow to allow Writes if the se are recorded durin g use of the application. Clinicians would also like to write the calculated per centiles (Observa tion Write) back to the pat ient' s reco rd so that the y may be included in pro gress notes . Neonat al Bilirubin Tracking: Enhancements mad e to this application by the UoflJ make the late st version significantly better th an the iCentra version. The app lication require s exact time of birth , bilirubin lab res ults (Observation , Read/Write ), and bilirubin light s thera py (Procedure ). The CDSsupport added to the application would allow orderin g of light therapy or tran sfusion (Order , ProcedureRequest). Opioid Management: The application requir es fully spe cified Medication , Encounter and labrelated (Observation ) Resource s, where all stru ctured eleme nt s (including medication route and frequency) use stand ard code system s. Device Interoperability Pilot: We are working with the Center for Medical Interop era bility on a FHIR-based standard for de vice data interchan ge. (Cemer is a member of C4MI, too. ) For this pilot, we need the ability to write device data (Observa tion) to the patient re cord , and collect information about a Device. Refe rral/Sched uling Management: The first use case for this application is for surgery referral req uests and the workt1ow events that occur until the episode concludes (including the followup with the referrin g ph ysician). The application s requir es a Procedur eReq uest Resource (Read/Writ e), C-CDADocument (Document Referen ce, Binary, Read/Write ), Procedu re, Patient and Encounter Referen ces, as well as informatio n about the Organization , Practitioner, HealthcareService Health Information Exchange Data Viewer: The Viewer application allows users to view hea lth information exchange information shar ed from other organiza tions, perform reconciliation , VA-18-0298-I-000514 3 Page 1132 of 2g1~ of 1380 Requests fo r Gerner EHR platform to Suppor t Innovation and Interoperab ility smh.docx for Printed Item: 409 ( Attachment 2 of 3) req uest data from ot her organizations, and create C-CDAdocuments to shar e with other organizat ions. The application requires Read and Write capabilities for C-CDAdocuments , as well as the ability to read sect ions of the patient's medical record in order to create a C-CDA document (e.g., Medication, Condition , Allergylntolerance, Observat ion, Patient , Encount er, Procedure, etc.). Advanced featur es include the ability to decompose a C-CDAfrom another institution and Write the structured data into the patient' s record. Open ApplicationFramework The Open Application Framework refers to technology needed to integrate 3 rd party applications within the "application de sktop" of the Cemer EMR(Millennium/ iCentra). This includes the ability to open an application directly from the EMR,keep the application's window within the parent windo w of the EMR, to suppo rt a security model allowing management of the security stat us of the application, and shar e application context (user , patient, enco unter , etc.) with the applicatio n. Intermo untain and Cemer have agreed that the SMARTsta nd ard will be used for this framework. Cerner currently implements this by providing an mPage wrapper around a generic SMARTcont ainer in which the 3rd party app is hosted . The app can be launched from a link within the iCentra left-hand navigation menu. For example, the Pediatric Growth Chart SMARTon FHIRapp is currently available in production in iCentra and can be launched from the navigation menu. An enhanceme nt that would be useful for several of the example applicatio ns is the ability to launch or embed application s from other locations within the EMR.For example, it would be more efficient for the Growth Chart app to be embedded directly within the clinician's workf1ow mPage so that it can be viewed in context with other information about the patient (without having to navigate to a separate app in the menu ). We have also discussed the ability to launch apps from tracking boards (e.g., Launch Point ), for example the ability to launch the PE diagnostic tool when an indicator on Launch Point suggests a possible pulm onary embolus that need s to be evaluated using the tool. The Bilirubin Tracking and Opioid Management apps would also benefit from such integration. A general facility to comm unicate information from external processe s would also be of value . The ability to publish data and events for applications to subscribe to invites asynchronous creatio n of observations , reminders , suggestio ns, and alert s. We would welcome the opportunity to work with Cerner to develop an efficient and effective mechanism to integrate these me ssages into the clinical workflow. A part of this can be accomplished using the CDSHooks technology de scribed below. In addition, we need to work with Cerner to handle other aspects of open application inte gration, such as hand ling of additio nal contexts and the ability to comm unicate from the app back to the EMR(in addition to FHIRdata services) in order to perform other function s such as place an ord er on the order scratc hpad , switch context, or launch another app lication. Open CDSIntegration VA-18-0298-I-000515 4 Page 1133 of 2g1~ of 1380 Requests fo r Gerner EHR platform to Support Innovation and Intero perabi lity smh.docx for Printed Item: 409 ( Attachment 2 of 3) EMRsbecome much more robu st and functional when they support clinical de cision support (CDS), parti cularly when that CDSis delivered at th e right time to the right per son. There is growing support in the hea lth care community for using CDS services that allow decision support content to be available from any tru sted source and located either within the walls of the institution or EMRpro vider , or externally (in the "cloud"). Cerner is actively supportin g the HL7 CDSHooks standard for pro viding 3 rd party CDSservices . The CDSHooks standard allows triggers ("hook s") from the EMR to call externa l services that pro vide respon ses in the form of information, suggestions and app links. The supported event triggers are a small se t of the potent ial triggers that may be nee ded in the future , and the current methods for displaying the respon ses are limited. Intermountain and Cerner need to work together to expand both the set of triggers and the methods for handlin g the re spon ses. We shou ld also work with Cemer to pu sh the testing and implementation of the app link CDSHook respon se in order to launch example applications like the PE, Opioid Management, and Bilirubin tools. The supported triggers also nee d to expand beyond just user events (e.g., "Open patient chart ", "Order med ") to events triggere d by internal actions (e.g., storing of an observation, result of a Discern rule). We need to stay informed about the Clinical Query Langua ge (CQL)HL7 standard for expressing decision support logic in a stand ard format so that the se knowled ge artifacts may be easily shared. While considering CDS, we should also think beyond th e single-sess ion decision support rules that drive many of the alerts, rem inder s and sugges tions that clinicians typically see, and also address the infrastructure needed to support long-runnin g, state ful pro cesses such as are found in care pro cess mod els. HL7 and OMG are working on applying bu siness pro cess mod eling standard s to healthcar e, and the se may significantly enhance th e way we deve lop and deliver CDS.Example applications such the PE tool involve stateful proce sses. Intermountain 's version of this tool utilizes an open sour ce BPMN engine, and we need to encourage Cemer to look at this te chnology in ord er to support inno vation capabilities on their platform . Open Development Tools Open Development Tools may be used by development group s to develop applications (loosely defined as user-facing application s as well as se rvices, CDSlogic and other knowledge artifacts) using the open service, application and CDSstandard s mentioned above. These tools make it easier and more efficient to de velop applications whose underlyin g terminolo gy, data model s and integrations are synta ctically and semant ically correct. The tools would incorporate FHIR profiles and FHIRterminolo gy services . Cemer could have a true innovation platfo1m if the y pro vided such too ls to 3rd p arties as part of the ir platform. They could ensure that any application built using these tools would work out of the box and could be interop era ble across any of their other customers using the op en standard s. Assuming commo n adoption of interoperabilit y standard s across vendor s, the applications may also be assured of working across vendor EMRs. This will re sult in a knowledge sharin g comm unity, and one where the entire healthcar e indu stry becomes a learning healthcar e system . VA-18-0298-I-000516 5 Page 1134 of 2g1~ of 1380 Document ID: 0.7.1705.510733-000003 Owner: Blackburn, Scott R. Filename: suggestions to VA on the contract.docx Last Modified: Wed Mar 21 12:23:35 CDT 2018 VA-18-0298-I-000517 Page 1135of2 5l~of1380 suggestions to VA on the contract.docx for Printed Item: 409 ( Attachment 3 of 3) 1. Read and write of all pat ient specific data through FHIRAPis and services by [specific da te] po st signing a. Cerner progress on comprehensive support ofFHIR has been slow. Only a few development resources are working on FHIRservices. There should be timelines or at least a resource commitment of some kind to make sure continued development of FHIRresource s is a priority. 2. Support for CDSHooks 3. Support for an HL7 approved publish and subscribe (pub/sub) infrastruct ure and se rvices. 4 . Support model driven application development tools that use FHIRre sources and profile s 5. Support a "time drive" infrastructure and services . 6. Provide a terminolo gy server that is compliant with the FHIRTerminolo gy Module 7. Support a knowledge repository for all kinds of knowledge artifacts: CDSlogic, FHIRprofiles, order sets, workflows, etc. 8. Provide the ability for th e VAto quickly change workflows. Currently, workflows are hard coded into the applications. It makes it nearly impossible to change workflows to accommodate changes in clinical practice. 9. Specify the time frame after a new version of FHIRis approved that Cerner will upgrade its services - one year? 10. Support VAor other 3 rd party defined FHIRprofiles a. Use of FHIRprofiles in model driven app lication development b. Ability to te st conformance of an application to a specific set of FHlRprofiles c. Services automatically te st conformance to profiles in the Cerner FHIRse rvices 11. It is difficult to discern an overall arc hitecture for the desired syste m. I think there is a dan ger that Cerner will just add more unmaintainable code ("bolt-on functionality") to the existing spaghetti bowl to meet VArequir eme nts , rather than creating a thou ghtful new next-generation system. Would it be po ssible to add a dia gram that would show a high level view of the future system with the re lation ship to external system s, etc.? 12. I think several of the requirements listed in "003 - VAEHRM Non-Functional RTM (Amended 2.16.2018)" are unreasonable and/or infeasible. VA-18-0298-I-000518 Page 1136 of 2g1~ of 1380 Document ID: 0.7.1705.510715 From: Blackburn , Scott R. To: Bruce Moskowitz IP ; Cc: mbsherman@gmail.com Bee: RE: [EXTERNAL] Stan Huff Subject: Wed Mar 21 2018 13:08:52 EDT Date: Attachments: Copy of 003 - VA EHRM Non-Functional RTM (Amended 2.16.2018) smh .xlsx Requests for Gerner EHR platform to Support Innovation and Interoperability smh.docx suggest ions to VA on the contract.docx Figured it out. Here are the files/notes that Stan wrote up for us ... -----Original Message ----,... - -----------. From: Bruce Moskowitz l(b)(S) Sent: Wednesday , March 21 , 2018 11 :30 AM To : Blackburn, Scott R. @gmail.com Cc: IP;j(b)(6) Subject: [EXTERNAL] Stan Huff @mac.com] Can you send his notes to us? Thank you Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000519 Page 1137 of 2i~i of 1380 Document ID: 0.7 .1705.510696-000001 Owner : Blackburn , Scott R. Filename: PHI RE: [EXTERNAL] RE: EHR VA Call (1).msg Last Modified: Wed Mar 21 12:03:43 CDT 2018 VA-18-0298-I-000520 Page 1149 of 2 52~of 1380 To: PHI RE: (b)(6) IWJHcl6~.Lb§nn~~.Y~~~M -~Ri-cf~g~!C\1~ iete1l!lre~~tiM~8~m1k~abocioexe@va.gov] ; l._ (b_ )(G_ ) ____. va.gov]; Blackburn , Scott R.[Scott.Blackburn@va.gov] c: From: Sent: tan u Wed 3/21/2018 1 :59 :29 PM Subject: PHI RE: [EXTERNA L] RE: EHR VA Call Secure Message Delivery From: Stan Huff Subject: lll PHI RE: [EXTERNAL] RE: EHR VA Call View Message Message avai lable on line until 05/20/2 018. Use your password to access the message. VA-18-0298-I-000521 Page 1150 of 2~1~ of 1380 Document ID: 0.7.1705.1539524 From: Bruce Moskowitz @mac.com> Blackburn , Scott R. 6l 1p; (b)(6) gmail.com --k b-l/-6l___ @gmail.com> l(b)(6) To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Stan Huff Wed Mar 21 2018 11 :29:48 EDT Can you send his notes to us? Thank you Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000522 Page 1151 of 2i1~of 1380 Document ID: 0.7.1705.1774187 From: Blackburn, Scott R. Marc Sherman (b)(6) @gmail.com> ; To: Bruce Moskowitz l(b)(6) @mac .com> Cc: Windom , John H. ; (b)(6) /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Stan Huff Subject: Tue Mar 20 2018 22:30:34 EDT Date: Attachments: Bruce/Marc - thanks for introducing us to all the experts we talked to ton ight. It was extremely valuable. We have Stan Huff from lntermounta in tomorrow at 10am. just in case it isl(b)(6) I I assume you have the calendar invite, but We have been unable to schedule anything with Dr. Ko (very busy calendar). We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000523 Page 1152 of 2i1~ of 1380 Document ID: 0.7.1705.510036 From: Blackburn, Scott R. To: (b-;:: )(=6)====== ::::!:::~ g.:..:. m.:.: a::..:. il.:...:; .com>; Marc Sherman i.:... (b-')('6) -''--- ____ __.@mac.com> Bruce Moskowitz "'"l Windom , John H. Cc: ; l(b)(6) Bee: Stan Huff Subject: Tue Mar 20 2018 22:30:34 EDT Date: Attachments: I Bruce/Marc - thanks for introducing us to all the experts we talked to tonight. It was extremely valuable. We have Stan Huff from lntermountain tomorrow at 10am . I assume you have the calenda r invite , but just in case it isl(b)(6) I We have been unable to schedule anything with Dr. Ko (very busy calendar) . We will trying. Scott Scott Blackburn Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000524 Page 1153 of 2i1iof 1380 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-I-000525 Page 1154 of 2 52~of 1380 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.o. l(b)(S) l@mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM .:~l(b ~)(~6~ ) ---~-~ To: Blackburn, Scott R,.... Cc: Windom, John H.; l(b)(6) !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 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-I-000526 Page 1155 of 2i1iof 1380 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: Monday , March 19, 20 18 at 2:39 PM To: l(b)(6) ~va .gov>, "Cooper , Leslie T. , M.D.",_l Cc: "Windom, John H." , l(b)(6) @va.gov>, "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 cove r that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott (b_)(_S)______ _, From: ._l Sent: Monday, March 19, 20181:38 PM To : Cooper, Leslie T., M.D. (b_)(6 _)___ 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, ~ VA-18-0298-I-000527 Page 1156 of 2i1~of 1380 From: Cooper, Leslie T., M.D.l(b)(6) l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: !(b)(6) Cc: Blackburn , Scott R.; Windom, John H.;l~ (b_)(6 _)___ ~ 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 6l ________________ Fromj...... (b_)(_ ~ Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ."!(b)(6) Cc: "Blackburn , Scott R.", "Windom , John H." , l(b )(6) I 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) l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs VA-18-0298-I-000528 Page 1157 of 2i1iof 1380 Desk: 202-461-6288 Celt: (We) Page 1158 01?23512g0f 1380 Document ID: 0.7.1705.510033 From: Myklegard, Drew To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 22:18:47 EDT 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 From: Cooper, Leslie T. , M.D (b)(6) mayo.edu] Sent: Tuesday , March 2;,,L,--,......_UL..::i:.......>L...L....J.U.. _ __, To : Blackburn, Scott R,.,., ...., · (=b)=(6=) ====.--~ Cc: Windom, John H. (b)(6) Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, VA-18-0298-I-000530 Page 1159 of 2i1iof 1380 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 To: (b)(6) va.gov>, "Cooper , Leslie T., M.D." (b)(6) ~----------~ l(b)(6) ~--~ ®va.gov>, "Short , VA-18-0298-I-000531 Page 1160 of 2i1~of 1380 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 6)______ From l~ (b_)(_ ~ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R.; Windom , John H.;l~(b_)(_ 6)____ 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) 6l______ From : Cooper, Leslie T. , M.D .._l (b_)(_ Sent: Saturday , March 17, 2018 9:36 PM TO :l(b)(6) -=@mayo.edu] I Cc: Blackburn , Scott R.; Windom, John H.; ~l (b_)(_6l____ 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 VA-18-0298-I-000532 Page 1161 of 2i1~of 1380 From: l(b)(6) l@va.gov> Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ." l(b)(6) Cc: "Blackburn. Scott R.", "Windom, John H." , l(b)(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 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) 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._ (b_)(6_) ___ _. VA-18-0298-I-000533 Pag e 1162 of 2i1~ of 1380 Document ID: 0.7.1705.509993 From: Blackburn , Scott R. To: Zenooz, Ashwini ; Windom, John H. Cc: Bee: Subject: Advisory Committee Date: Tue Mar 20 2018 21 :17:22 EDT Attachments: Let's start putting this together with ASAP. I know I have thoughts and "favorites". I am sure you guys do to. My candidates (Just off top of my head). Stephanie Reel (Hopkins) Jon Manis (Sutter) Rasu (UPMC) Shafiq Rab (Rush) Cris Ross (Mayo) Vivek Reddy (lntermountain) Aneesh Chopra Ryan Howells (Leavitt Partners) Frank Opelka (American College of Physicians) Will Morris or Ed Marx (Cleveland Clinic) Dr. Andy Karson (Mass General Hospital) Dr. Bruce Moskowitz (Tenet) Alistair Erskine (Geisinger) Daniel Barchi (New York Prespyterian) Scott Blackburn VA-18-0298-I-000534 Page 1163 of 2 5!~of 1380 Executive in Charge, Office of Information & Technology US Department of Veterans Affairs VA-18-0298-I-000535 Page 1164 of 2 5!~of 1380 Document ID: 0.7.1705.509988 From: Blackburn , Scott R. Coo er, Leslie T., M.D. To: (b)(6) mayo .edu> Cc: Bee: Subject: RE: [EXTERNAL] RE: RE: RE: VA EHR Call Update Date: Tue Mar 20 2018 20:23:02 EDT 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) From: Cooper, Leslie T. , M.o j(b)(S) @mayo.edu] Sent: Tuesday , March 20 , 2018 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 @mayo.edu] From: Cooper, Leslie T. , M.D. ~b)(6) Sent: Tuesday , March 20, 201 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-I-000536 Page 1165 of 2i1iof 1380 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 From: Cooper , Leslie T. , M.D.l(b)(6) @mayo.edu] Sent: Tuesday , March 20 2018 4:25 PM To: Blackburn, Scott Rt:'.';"-; (b-;;--: )(6 _)____ :-,-____J 6 Cc: Windom, John H.; (b)( ) 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 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-I-000537 Page 1166 of 2i1~of 1380 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: Monday , March 19, 2018 at 2:39 PM 5 To:l(b~) l@va .gov>, "Cooper , Leslie T., M.D." ~l (b_)(_l__ ~ 6 l(b)( ) ~mayo .edu> Cc: "Windom , John H." j(b)(G) 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 I Fromj(b)(G) Sent: Monday , March 19, 20181:38 PM .--------, To: Cooper , Leslie T., M.D. 6 )____ Cc: Blackburn , Scott R.; Windom , John H.: (b_)(_ Subject: RE: [EXTERNAL] VA EHR Call Update l.... _. 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-I-000538 Page 1167 of 2i1iof 1380 Thanks, Liz From: Cooper, Leslie T. , M.Dl(b)(6) l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) 6)___ Cc: Blackburn , Scott R.; Windom, John H.; ~l (b_)(_ ~ 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 l§va.gov> From: l(b)(6) Date: Saturday, March 17, 2018 at 12:13 PM To : "Cooper, Leslie T., M.D ." !(bl(6l @mayo.edu> Cc· "Blackburn Scott R" , "Windom, John H." , l(b)(6)lw,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! l(b)(6) l(b)(6) Executive Assistant to the Assistant Secretary VA-18-0298-I-000539 Page 1168 of 2i1iof 1380 Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce11:l(b)(6) VA-18-0298-I-000540 Page 1169 of 2i1iof 1380 Document ID: 0.7.1705.509983 From: Cooper, Leslie T., M.D. l(b)(6) @mayo.edu> To: Blackburn , Scott R. Cc: Bee: Re: [EXTERNAL] RE: RE: RE: VA EHR Call Update Subject: Tue Mar 20 2018 20 :17:08 EDT Date: 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 From: Cooper, Leslie T. , M.D. l(b)( 6 ) @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-I-000541 Page 1170 of 2i\~ of 1380 From: Cooper, Leslie T. , M.D. l(b)(S) @mayo.edu] Sent: Tuesday , March 20 2018 4:25 PM To: Blackburn, Scott )"-'(b~)(~6)________ ____. Cc: Windom, John H.; (b)(6) 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 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 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 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 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 requ ired 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 Tru sted 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-I-000542 Page 1171 of 2i\~ of 1380 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 (b_)(6 _)__ ~ To:l(b)(6) @va .gov>, "Cooper , Leslie T., M.D." ~l 6 !(b)( ) @mayo .edu> Cc: "Windom , John H." , l(b)(6) t§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<~.lrnL ::,, ,~,,, Sent: Monday, March 19, 20181:38 PM To : Cooper , Leslie T. , M.D. 5 Cc: Blackburn , Scott R.; Windom, John H.;~(b_)(_l ___ Subject: RE: [EXTERNAL] VA EHR Call Update I ~ 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 (b_)(_ l_____ Sent: Saturday, March 17, 2018 9:36 PM To j(b)(6) ~ @~mayo.edu] I VA-18-0298-I-000543 Page 1172 of 2i\~ of 1380 Cc: Blackburn , Scott R.; Windom, John H.~J (b_)(_6)____ Subject: Re: [EXTERNAL] VA EHR Call Update Impo rtance: 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 @va.gov> From: l(b)(6) Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper , Leslie T ., M.D."l(b)(6) @mayo.edu> Cc: "Blackburn , Scott R.", "Windom, John H." , l(b)(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 Ce11 :l(b)(6) VA-18-0298-I-000544 Page 1173 of 2i1iof 1380 Document ID: 0.7.1705.509951 From: Blackburn , Scott R. Coo er, Leslie T., M.D. To: (b)(6) mayo .edu> 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 @mayo.edu] From: Cooper, Leslie T ., M.D~b)(6) Sent: Tuesday , March 20, 20 8 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 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 From: Cooper, Leslie T. , M.D.l(b)(6) ~mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott R · l(b)(6) l(b7:' )(6 ~)'-'------,..I S _h _o_rt_,JJohn (VACO) Cc: Windom , John H.;t:Subject: Re: [EXTERNAL] RE: VA EHR Call Update VA-18-0298-I-000545 Pa ge 1175 of 2i\~ of 1380 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 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. 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 " w ith no way to identify file content or cor relate 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 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 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 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 examp le, a coronary angiogram report at an outside fac ility performed in January 2018 should appear in the VA EMR under Cardio logy Testing (nomenclature from Gerner 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 Federa l 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 dur ing 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 VA-18-0298-I-000546 Page 1176 of 2 54~of 1380 From: "Blackburn, Scott R." Date: Monday, March 19, 2018 at 2:39 PM Jo j(b)(6) @va .gov>, "Cooper , Leslie T., M.D." i(b)(6) l(b)(6) @mayo .edu> '-"-'-'-...;....__...., Cc: "Windom , John H." ,l(b)(6) t@va.gov>, "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 I From:l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. .-------. Cc: Blackburn , Scott R.; Windom, John H.:l..... (b_)(G_ 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) 6 From: Cooper, Leslie T. , M.DJ.... (b~)(_l_~---~ @mayo.edu] Sent: Saturday, March 17, 20 ~8 9:36 PM To: l(b)(6) Cc: Blackburn , Scott R.; Windom, John H.:l~ (b_)(6 _)____ Subject: Re: [EXTERNAL] VA EHR Call 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-I-000547 Page 1177 of 2i\~ of 1380 Wednesday I could make a call after 6:30 pm. Leslie @va.gov> From: l(b)(6) Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T., M.D." l(b)(6) Cc: "Blackburn, Scott R.", "Windom , John H." , l(b)(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 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 Cell : l(b)(6) VA-18-0298-I-000548 Page 1178 of 2i1iof 1380 Document ID: 0.7.1705.390040 From: Bruce Moskowitz l(b)(6) ~mac.com> To: Sandoval, Camilo 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: l(b)(6) Subject: FW: [EXTERNAL] RE: VA EHR Call Update From: Cooper, Leslie T. , M.D. (b)(G) mayo.edu] Sent: Tuesday , March 2~ 2"""'-'1..><.......C="-'-!.!.1-~ To: Blackburn, Scott ~ · ~ (b-)(_ 6)_____ _____, 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 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-I-000549 Page 1179 of 2i1iof 1380 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- Monday March 19 20 18 at 2·39 PM To:~ )(6) ~va .gov>, "Cooper , Leslie T. , M.D." l(b)(S) l(b)(6) @mayo.edu> ~---------~ Cc: "Windom, John H." j(b)(S) l@va.gov>, "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update I 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-I-000550 Page 1180 of 2iY6 of 1380 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott From J~ (b_)(S_ ) _____ ~ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. ~-----~ Cc: Blackburn , Scott R. ; Windom, John H.J.... (b_)(_6 )____ 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.o. l(b)(S) @mayo.edu] Sent: Saturda , March 17 2018 9:36 PM To : (b)(6) Cc: ac urn, cott .; indom , John H.; ..... l(b_)(_6 )____ ~ 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:l(b)(6 ) @va.gov> Date: Saturday , March 17, 20 [!8 at 12:13PM To: "Cooper, Leslie T., M.D." (b)(6) J@mayo.edu> Cc: "Blackburn. Scott R.", "Windom , John H." , l(b)(6 ) l@va.gov> VA-18-0298-I-000551 Pa ge 1181 of 2i~ of 1380 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)(G) VA-18-0298-I-000552 Pa ge 1182 of 2i~ of 1380 Document ID: 0.7.1705.509949 Blackburn, Scott R. Myklegard, Drew Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 20:00:46 EDT Attachments: From: Cooper, Leslie T. , M.Dj(b)(G) @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott R · l(b)(Gl Cc: Windom, John H.;t:;" l(b~ )(G~ )~----,_I S_h_o__J rt, 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-I-000553 Page 1183 of 2i~ of 1380 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(b)(6) k.atva.gov>,"Cooper, Leslie T., M.D." Cc: "Windom, John H." , l(b)(G) 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 (b_)(6 _)_____ ~ From: ~l Sent: Monday, March 19, 20181:38 PM To: Cooper, Leslie T., M.D. .--------. 5 Cc: Blackburn, Scott R.; Windom, John H.; ~l (b_)(_ l____ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-I-000554 Pa ge 1184 of 2iYa of 1380 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)(G) @mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To :l(b)(6) Cc: Blackburn , Scott R.; Windom, John H.;l._ (b_)(6 _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) ~va.gov > Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D ." l(b)(6) @mayo.edu> Cc: "Blackburn, Scott R." , "Windom, John H." , l(b)(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? Thanks again! VA-18-0298-I-000555 Pag e 1185 of 2iYs of 1380 (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) VA-18-0298-I-000556 Page 1186 of 2i~ of 1380 Document ID: 0.7.1705.509936 Blackburn , Scott R. Myklegard, Drew Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 19:34:36 EDT Attachments: From: Cooper, Leslie T. , M.D. l(b)(6) @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott~ ·l(b)(6) Cc: Windom, John HJ~(b~ )(6 -::)._.____ l-l 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 regarding 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 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-I-000557 Page 1187 of 2im, of 1380 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-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(b)(6) @va.gov>, "Cooper, Leslie T., M.D." l(b)(G) .____ _. l(b)(6) l@mayo .edu> 6 Cc: "Windom, John H." j(b)( l t@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 FromJ_ (b_)(_6l_ _____ ~ Sent: Monday, March 19, 20181:38 PM .--------. To: Cooper, Leslie T., M.D. Cc: Blackburn, Scott R.; Windom, John H.;~l (b_)(_6l____ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-I-000558 Pa ge 1188 of 2iYs of 1380 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) 6l_____ From: Cooper, Leslie T. , M.D._l (b_)(_ ~ @.__..mayo.edu] Sent: Saturday , March 17. 2018 9:36 PM To : l(b)(6) 6l____ Cc: Blackburn , Scott R.; Windom, John H.:l.... (b_)(_ ___, 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 _.. From:,_l (b_)(_6)_________________ Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ."!(b)(6) Cc: "Blackburn, Scott R." , "Windom, John H." , l(b)(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 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-I-000559 Pag e 1189 of 2i~ of 1380 (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-)(G_ J___ ~ VA-18-0298-I-000560 Page 1190 of 2i1iof 1380 Document ID: 0.7.1705.509933 Blackburn , Scott R. To: Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 201819:34:04 EDT Attachments: 1> From: Cooper, Leslie T. , M.o J(b)(G) l@mayo.edu] Sent: Tuesday , March 2 2 1 4:2 PM To : Blackburn, Scott R""..... ·(b _)_ (6_) ---......-----' Cc: Windom, John H.;(b)(6) Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update Scott, I reviewed the materi al you sent regarding the proposed VA EMR contract and state ment 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, 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 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 needless ly repeated at substantial cost and risk to patients. I recommend that the VA EMR contract and statement of work be amended to requ ire 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 VA-18-0298-I-000561 Page 1191 of 2i1~of 1380 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: Monday, March 19, 2018 at 2:39 PM ~ @va.gov>, "Cooper , Leslie T. , M.D." ~(b)(6), (b)(6) mayo .edu> Cc: "Windom, John H." , "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 l(b ~l(~6l.......,.. _____ ~ From: ~ Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. 6)____ Cc: Blackburn , Scott R.; Windom, John H.;-l(b_)(_ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-I-000562 Pa ge 1192 of 2i1~ of 1380 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, Liz From: Cooper, Leslie T. , M.D.l(b)(6) @mayo.edu] Sent: Saturday , March 17! 2018 9:36 PM To: l(b)(6) . 5 -)(_l___ ___. Cc: Blackburn , Scott R. ; Windom, John H.; ~b Subject: Re: [EXTERNAL] VA EHR Call Update Importance : High l..... 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) @va.gov> Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D." l(b)(6) l@mayo.edu> Cc: "Blackburn, Scott R.", "Windom, John H." , l(b)(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 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-I-000563 Page 1193 of 2i1~of 1380 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-I-000564 Page 1194 of 2i1iof 1380 Document ID: 0.7.1705.509931 Blackburn, Scott R. DJS Cc: Bee: Subject: FW: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 19:33:35 EDT Attachments: From: Cooper, Leslie T. , M.o .Kb)(S) @mayo.edu] -'-""-="""-'----1.lU --~ Sent: Tuesday , March 2.~""-"'-1 To: Blackburn, Scott ~ -(~ b)~(6~) ----.---~ Cc: Windom, John H.;(b)(6) 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 "Outs ide 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-I-000565 Page 1195 of 2i1~of 1380 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 Jo · l(b)(6) @va .gov>, "Cooper , Leslie T. , M.D." l(b)(6) l(b)(G) @mayo .edu> ~---~ 6 Cc: "Windom , John H." ,l(b)( ) @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 (b_)(_6 )_____ ___, From: ._l Sent: Monday, March 19, 2018 1:38 PM To: Cooper , Leslie T. , M.D. ..---------, Cc: Blackburn , Scott R.; Windom, John H.;._l (b_)(_5 )____ Subject: RE: [EXTERNAL] VA EHR Call Update ___. VA-18-0298-I-000566 Page 1196 of 2i1iof 1380 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, r b)(6) 6l______ From: Cooper, Leslie T., M.D .._l (b_)(_ ~@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) 6l____ Cc: Blackburn , Scott R.; Windom, John H.;l._ (b_)(_ ~ 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 (b_)(_6l_________________ ~ From: ._l Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper , Leslie T ., M.D." l(b)(6) Cc· "Blackb11rn Scott R" , "Windom, John H." , l(b)(S) J@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-I-000567 Page 1197 of 2i1~of 1380 (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) VA-18-0298-I-000568 Page 1198 of 2i1iof 1380 Document ID: 0.7.1705.509920 Blackburn, Scott R. 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.Dl(b)(6) @mayo.edu] Sent: Tuesday , March 20, 20 18 4:25 PM To: Blackburn, Scott R.: l(b)(6) Cc: Windom, John H.;l(b)(6) S hort, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update 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 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-I-000569 Page 1199 of 2i1iof 1380 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 Jo · l(b~ ) @va .gov>, "Cooper, Leslie T., M.D." l(b)(6l l(b)(S) ffimayo .edu> ~--~ 6 Cc: "Windom, John H." ,l(b)( ) @va.gov>, "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 l(b_)(_6)______ __, From:..... Sent: Monday, March 19, 2018 1:38 PM To: Cooper, Leslie T., M.D. Cc: Blackburn, Scott R.; Windom, John H.:l~ (b_)(_ 6)____ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-I-000570 Page 1200 of 2iWJ of 1380 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) 6).,....,,.....=-:-:,----~ @mayo.edu] From: Cooper, Leslie T., M.D .....,,l (b...., )(,..... Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) Cc: Blackburn, Scott R.; Windom, John H.: l~ (b_)(6 _)___ ~ Subject: Re: [EXTERNAL] VA EHR Call Upda te 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 6)_____________ From: -l(b_)(_ ~ @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Lesl ie T ., M.D." (b)(6) mayo.edu> tt,.,.. _.......,, a"""' c,..,.,.... u...., r...,.... n~-va.gov>, "Windom, John H." , Cc: "Blackburn, Scott R." 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-I-000571 Pa ge 1201 of2 i1A of 1380 (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_J___ ~ VA-18-0298-I-000572 Page 1202 of 2i~ of 1380 Document ID: 0.7.1705.475801 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandoval, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; l(b )(S) l(b)(S) } !o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce @mac .com>; Carolyn@Bruce Moskowitz l(b)(6) gmail.com>; Marc Sherman Moskowitz MD (b)(6) (b)( 6 ) gma1 .com>; ~ frenchangel59.com>; Foster, Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz, Ashwini ; Short, John (VACO) ; Myklegard, Drew ; (b)(6) /o=va/ou=exchange administrative gro..., u=p----~ (fydibohf23s dlt /cn=recipients/cn=vacocallae2>; Cooper, Leslie T., M .D. (b)( 6) mayo.edu> Cc: Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:02:30 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 : i(b)(6) Recurring: No ShowReminder: Yes ReminderMinutes: 15 ReminderTime: Tue Mar 20 18:15:00 Central Daylight Time 2018 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-I-000573 Page 1203 of 2i'% of 1380 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(b)(6) Moskowitz'; 'Carolyn@Bruce Moskowitz .MD'; 'Marc Sherman' ; 'IP' ; Foster, Michele SES ; Nostrant , David K.; Draper , Anne; Zenooz , Ashw ini; Short , John (VACO); Myklegard , Drew ; (b)(6) '------------' 'Cooper , Lesl ie T ., M.D.' Subject: VA EHR Call When : Tuesday , March 20, 2018 7:30 PM-8:00 PM . Where : 1-800-767-1750,22712# All, Dr. Cooper will not be able to partici ate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper . Thanks , (b)(6) (b_)(G _l __ Scheduling POC: !,_ ___,l 202-631-0640 ,__l (b_)(6 _l ____ __,@va.gov VA-18-0298-I-000574 Pa ge 1204 of 2i1/a of 1380 Document ID: 0.7.1705.390035 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandoval, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; ~1 (b)(6) o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce Moskowitz (b)(6) mac.com>; Carolyn@Bruce Moskowitz MD (b)(6) gmail.com>; Marc Sherman (b)(6) gma1 .com>; (b)(6 frenchangel59.com>; Foster, Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz, Ashwini ; Short, John (VACO) ; Myklegard, Drew ; ~l (b)(6) /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2>; Cooper, Leslie ~mayo .ed u> T., M.D. l(b)(6) 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(b)(6) 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-I-000575 Pag e 1205 of 2i'% of 1380 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 HJb )(S) Moskowitz'; 'Carolyn@Bruce Moskowitz.MD'; 'Marc Sherman' ; 'IP' ; Foster, Michele on behalf of VACIO Executive Schedule To: Sandoval, Camilo 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:(UTC-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 HJb)(G) Moskowitz'; 'Carolyn@Bruce Moskowitz .MD'; 'Marc Sherman' ; 'IP'; Foster, Michele SES ; Nostrant , David K. ; Draper, Anne; Zenooz , Ashwini; Short , John (VACO); Myklegard, Drew;( b)(6) ._ _______ 'Cooper, Leslie T., M.D.' _. Subject: VA EHR Call When: Tuesday , March 20, 2018 7:30 PM-8:00 PM. Where :l(b)(G) I All, Dr. Cooper will not be able to partici ate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper . Thanks ,(b)(6) (b_l(_6 l __ Scheduling POC: ._l _.l202-631-0640 ,_l(b_)(6_l____ ____. @va.gov VA-18-0298-I-000577 Page 1207 of 2i117 of 1380 Document ID: 0.7.1705.475785 From: VACIO Executive Schedule To: VACIO Executive Schedule ; Sandoval, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; J(b)(6) ; Bruce b 6 @mac .com>; Carolyn@Bruce Moskowitz l(b)(6) Moskowitz .MD (b)(6) mail.com> ; Marc Sherman l(b)(6) @gmail.com>; I (bl( 5 l frenchangel59.com>; Stephanie Reel b 6 'hu .edu> ; Mary 1or an (b)(6) 'hu.edu>; Ashley Johnson (b)(6) @jhmi.edu>;(,.__b)(6) ; Rasu Shrestha (b)(6) gmail.com>; Manis , Jonathan (Jon) (b)(6) sutterhealth.org>; Shrestha, Rasu B (b)(6) upmc .edu>; Cooper, Leslie T., M.D. b 6 mayo.edu >; Karson, Andrew Scott,M.D. (b)(6) mgh .harvard .edu >; Zuccala , Kandace (Kandi) R. rhealth.org > ~~,.... o-r-r-rJFo~(b~ )t(;.6~ ) facs.org>; Mehwe sh Cc: @imail.org> Khalid (b)(6) facs.o rg>; Stan Huff -l(b-)(-6)-~l Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:01 :52 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 I Location : !rb}/6} Recurring: No ShowReminder: Yes ReminderMinutes: 15 ReminderTime: Tue Mar 20 18:45:00 Central Daylight Time 2018 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-I-000578 Page 1208 of 2i1/s of 1380 From: VA CIO Executive Sched ule Sent: Sunday , March 18, 2018 2:30:57 PM Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom , John H.: l(b)(6) Moskowitz ; 'Carolyn@Bruce Moskow itz.MD' ; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley IRasu Shrestha ; Manis , Jonathan (Jon) ; Shrestha , Rasu B; Cooper , Johnson ;l(b)(6) Leslie T. , M.D. ; Karson , Andrew Scott ,M.D.; Zucca la, Kandace (Kandi) R. Cc: Cl ifford Ko; Mehwesh Khalid ; Stan Huff Subject: VA EHR Call When : Tuesda y, March 20. 2018 8:00 PM-9:30 PM. Where :l(b)(6) I I Schedul ing POC :l._ (b_)(G _l __ _.l202-631-0640 and l~ (b_)(6 _l ____ ~J @va .gov All, I am inc luding everyone in the group in case anyone has any last minute scheduling changes. Thanks , l(b)(6) I VA-18-0298-I-000579 Page 1209 of 2i'% of 1380 Document ID: 0.7.1705.390033 From: VAC IO Executive Schedu le To: VACIO Executive Schedule ; Sandoval, Camilo J. ; Blackburn, Scott R. ; Windom, John H. ; ~l (b)(6) ; Bruce Moskowitz (b)(6) mac.com>; Carolyn@Bruce Moskowitz .MD (b)(6) mail.com> ; Marc Sherman (b)(6) gmail.com>; I (b)<5) frenchangel59.com>; Stephanie Reel (b)(6) 'hu.edu> ; Mary Riordan (b)(6) 'hu.edu>; Ashley Johnso (b)(6) jhmi.edu>; ,..__ (b)(6) ; Rasu Shrestha (b)(6) gmail.com>; Manis , Jonathan (Jon) ~~-.....,.,_.c.::.., su erhealth.org>; Shrestha, Rasu B i:-,.:..;:.....:.,___ ~ upmc .edu>; Cooper, Leslie T., M.D. @mayo.edu>; Karson, Andrew Scott,M.D. ~:=-:-----i-=---' i,:...:.:....:.......i:=mgh.harvard .edu >; Zuccala , Kandace (Kandi) R. (b)(6) sutterhealth.org> Clifford Ko (b)(6) facs.org>; Mehwe sh Cc: Khalid (b)(6) facs.o rg>; Stan Huff l~ (b-)(6-) -~ t@imail.org> Bee: FW : VA EHR Call Subject: Tue Mar 20 2018 19:01 :52 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(b)(6) Recurring: 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-I-000580 Page 1210 of 2i1i of 1380 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_j(b)(G) Moskowitz· 'Carol n Bruce Moskowitz,MD' ; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley Johnson ; (b)(6) 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(b)(6) I Scheduling POC: ,__l (b_ )(6_) __ __.I 202-631-0640 and ._l (b_)(G _) ____ __.l @va .gov All, I am inc luding everyone in the group in case anyone has any last minute scheduling changes. Thanks, l(b)(6) I VA-18-0298-I-000581 Page 1211 of 2i1~ of 1380 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 IBruce To : VACIO Executive Schedule; Blackburn, Scott R.; Windom, John H.l(bl(6l Moskowitz ; 'Carol n Bruce Moskowitz.MD' ; Marc Sherman; IP; Stephanie Reel; Mary Riordan; Ashley Johnson ;(b)(6) Rasu Shrest ha; 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(b)(6) I Scheduling POC:!._ (b_)(6_l __ ~l202-631-0640 and._l(b_)(_l ____ 5 ~ ~va .gov 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-I-000582 Page 1212 of 2i1~ of 1380 Document ID: 0.7.1705.1225558 From: Karson, Andrew Scott,M.D. l(b)(6) l@mgh.harvard.edu> VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; l~ l(b)(6) ~/o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm> ; Bruce @mac.com>; Carolyn@Bruce Moskowitz l(b)(6) Moskowitz ,MD (b)(6) mail.com> ; Marc Sherman (b)(6) gmail.com>; I (b)(6 frenchan el59.com>; Stephanie ee b s ·hu.edu> ; Mary 10 b 6 >; Ashley Johnson (b)(6) jhmi.edu>; (b)(6) ; Rasu Shrestha b s gmail.com >; Manis , Jonathan (Jon) (b)(6) sutterhealth.org>; Shrestha, Rasu B FJ..> ~--'=i upmc.edu>; Cooper, Leslie T., M.D . ....,,....,...,,,,.,,__-.......,,.__, ....., mayo .edu>; Zuccala, Kandace (Kandi) R. (b)(6) sutterhealth.org> Cc: facs.org>; Mehwe shr::-:-:-::-:----, Clifford Ko ~ Khalid l(b)(6) l@facs.org>; Stan Huff (b)(6) Karson, Andrew Scott,M.D. (b)(6) mg . Bee: [EXTERNAL] RE: VA EHR Call Subject: Tue Mar20 201818:04:17 EDT Date: Attachments: Dear l~ (b_)(S _) _ _.let 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 email 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-I-000583 Page 1213 of 2i1~ of 1380 Sent: Sunday , March 18, 2018 2:32 PM !Bruce To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John HJb )(G) Moskowitz· 'Carol n Bruce Moskowitz.MD' ; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley Johnson ; (b)(G) Rasu Shrestha ; Manis, Jonathan (Jon); Shrestha , Rasu B; Cooper , Leslie T. , .. ; arson , n rew 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). Where : l(b)(G) I Scheduling POC:!._ (b_)(6_) __ ___.l 202-631-0640 and ._l (b_)(6_)____ ~ @va .gov All, I am including everyone in the group in case anyone has any last minute scheduling changes. Thanks, l(b)(G) 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 contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-I-000584 Page 1214 of 2i1i of 1380 Document ID: 0.7.1705.509901 From: Karson, Andrew Scott,M.D. l(b)(6) @mgh.harvard.edu> VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ; (b)(6) ; I lbx6> frenchan Stephanie Reel (b)(6) 'hu.edu>; Mary Riordan (b)(6) _. Ashley John son (b)(6) jhmi.edu>; ._(b)(6) ; Man is, Jonathan (Jon) (b)(6) sutterhealth.org>; Shrestha, Rasu (b)(6) @upmc.e u>; Cooper, Leslie T., M.D. b 6 @mayo.edu>; Zuccala, Kandace (Kandi) R. (b)(6) sutterhealth.org > Clifford Ko b 6 facs.org>; Mehwe sh Cc: Khalid (b)(6) facs.org >; Stan Huff ~l (b-)(-6)-~ @imail.org >; Karson , Andrew Scott,M.D. l(b)(6) @mgh .harvard.ed u> Bee: [EXTERNAL] RE: VA EHR Call Subject: Tue Mar20 201818:04:17 EDT Date: Attachments: ______ Dear ~l (b_)(G_ ) _~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 email 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 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-I-000585 Pag e 1215 of 2i1~ of 1380 -----Original Appointment----From: VA CIO Executive Schedule [mailto:vacocioexe@va.gov] Sent: Sunday , March 18, 2018 2:32 PM To: VACIO Executive Schedule ; Blackburn, Scott R.; Windom, John H.;l(b)(G) Bruce Moskowitz · 'Carol n Bruce Moskowitz.MD' ; Marc Sherman ; IP; Stephanie Reel; Mary Riordan; Ashley Johnson ; (b)(6) 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 (UTC-05:00) Eastern Time (US & Canada). Where : l(b)(6) I I Scheduling POC:l..... (b_)(G _) __ ___,I 202-631-0640 and._l (b_)(6 _)____ _. l@va.gov All, I am including everyone in the group in case anyone has any last minute scheduling changes. Thanks, l(b)(6) 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 contain patient information, please contact the sender and properly dispose of the e-mail. VA-18-0298-I-000586 Page 1216 of 2i1i of 1380 Document ID: 0.7.1705.1225536 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn , Scott R. Cc: Draper , Anne ; ~l ; 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, Sert R, Cc: Draper , Anne; {b)(6) Zenooz , Ashwini; Short , John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update I 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 M..... D........_ ·l .... (b_...)( _. 6)__ .,____ ___J To: Cooper , Leslie T., l"': Cc: Windom, John HJ b)(6) ~ hort, John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update VA-18-0298-I-000587 Page 1217 of 2i1~ of 1380 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(b)(6) 1@mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To : Blackburn, Scott R.; (b)(6) __ ~------' Cc: Windom , John H.; (b)(6) 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 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-I-000588 Page 1218 of 2i1i of 1380 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__ l(b_)(_ ___, T : b)(6) va.gov>, "Cooper , Leslie T. , M.D." .... (b)(G) mayo .edu> @va.gov>, "Short , Cc: "Windom , John H." ,l(b)(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. Scott l(b_)(_ G)_____ ~ From:.... Sent: Monday, March 19, 20181:38 PM .--------. To: Cooper , Leslie T. , M.D. 6)___ Cc: Blackburn , Scott R.; Windom, John H.;l.... (b,.... )(_ 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-I-000589 Page 1219 of 2i1i of 1380 Thanks, Liz From: Cooper, Leslie T. , M.D. l(b)(6) k.a)mayo.edu] Sent: Satu rday , March 17, 2018 9:36 PM To: l(b)(6) I .-b- ------. 6 Cc: Blackburn , Scott R. ; Windom, John H.:I~( _)(_)____ ~ Subj ect: Re: [EXTERNA L] VA EHR Ca ll 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. Cou ld I call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From: l(b)(6) @va.gov > Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper , Leslie T ., M.D." l(b)(6) l@mayo.edu> Cc: "Blackburn . Scott R.", "Windom , John H." , l(b)(6) @va.gov> Subject: [EXTERNAL] VA EHR Ca ll Update Good afternoon Dr. Coope r, 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 Secre tary VA-18-0298-I-000590 Page 1220 of 2i1i of 1380 Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell : l._ (b_)(6_ ) ___ _. VA-18-0298-I-000591 Page 122 1 of 2i1~ of 1380 Document ID: 0.7.1705.509892 From: Zenooz, Ashwini Windom, John H. To: ; Blackburn, Scott R. Draper , Anne Cc: (b)(G) /o=exchangelabs/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2-truex , matt>; 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 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, Scott R. Cc: Draper, Anne; ,....l (b-)(-6)----..1 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) VA-18-0298-I-000592 Page 1222 of 2i1~ of 1380 From: Blackburn, Scott R. Sent: Tuesday, March 20, 2018 2:12:59 PM To: Cooper, Leslie T. , ~M":': .D ~,k...... b)..._ (6....._ ) __ --,.... __ ___J Cc: Windom, John H.; l(b)(6) !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 From: Cooper, Leslie T. , M.D. l(b)(6) l@mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn, Scott R;.:.i .:...._l (b....._ )(,6) .._ ,___ __ ~__ _. Cc: Windom, John H.;l(b)(6) !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 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 VA-18-0298-I-000593 Page 1223 of 2i1~ of 1380 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: Monday , March 19, 2018 at 2:39 PM To: l(b)(6) @va .gov>, "Cooper , Leslie T. , M.D."~l (b_)(_ 6)__ ~ l(b)(S) @mayo .edu> Cc: "Windom, John H." j(b)(6) @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. 6)___ Cc: Blackburn , Scott R.; Windom, John H.: l~ (b_)(_ Subject: RE: [EXTERNAL] VA EHR Call Update ~ VA-18-0298-I-000594 Page 1224 of 2i1i of 1380 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, Liz From: Cooper, Leslie T. , M.D.l(b)(6) k@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) Cc: Blackburn , Scott R. ; Windom, John H.; ..... l(b_)(_S)____ _. 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)(6l @va.gov > Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D." l(b)(6) @mayo.edu> Cc: "Blackburn , Scott R.", "Windom, John H." , l(b)(6) kotva.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-I-000595 Page 1225 of 2i1~ of 1380 l(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~ (b-)(6 - )---~ VA-18-0298-I-000596 Page 1226 of 2i1i of 1380 Document ID: 0.7.1705.1225470 Windom , John H. Blackburn, Scott R. Cc: Draper , Anne ;~j (b_)(_G)____ --=-' ; 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 , 21"-'-'...__.....__ ..................... ...___ _ __,, To : Cooper , Leslie T. , M.D.; (b)(G) Cc: Windom , John H.; b 6 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 From: Cooper, Leslie T. , M.D.l(b)(G) laJmayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn, Scott R,..... .:__.j,._ (b.,. )(6_. )___ ...----~ Cc: Windom , John H.; l(b)(G) !Short , John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update VA-18-0298-I-000597 Page 1227 of 2i1~ of 1380 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 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. 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 " w ith no way to identify file content or cor relate 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 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 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 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 examp le, a coronary angiogram report at an outside fac ility performed in January 2018 should appear in the VA EMR under Cardio logy Testing (nomenclature from Gerner 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 Federa l 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 dur ing 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 VA-18-0298-I-000598 Page 1228 of 2 59~of 1380 From: "Blackburn, Scott R." Date: Monday, March 19, 2018 at 2:39 PM @va .gov>, "Cooper , Leslie T., M.D." ~! (b~)(~6)__ ~ To· ! Cc: "Windom, John H." j(b)(6) @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, 20181:38 PM To: Cooper , Leslie T., M.D. (b_)(6 _)____ 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)(6) l.a2mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM TO :l(b)(6) Cc: Blackburn , Scott R.; Windom, John H.;l._ (b_)(6 _)___ __, 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? VA-18-0298-I-000599 Page 1229 of 2i1i of 1380 Wednesday I could make a call after 6:30 pm. Leslie Froml(b)(G) @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T., M.D." l(b)(G) @mayo.edu> Cc: "Blackburn , Scott R.", "Windom , John H." , !(b)(G) @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 (b_)(G_ ) ___ Cell: l._ _. VA-18-0298-I-000600 Page 1230 of 2ibi of 1380 Document ID: 0.7.1705.509674 Windom , John H. Blackburn, Scott R. Draper , Anne Cc: ; (b)(G) ; 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 dep ictio n 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 M.:..:..: .D =-•:..,_ : ..._l( b.... l(...,.G l____ .- __ ___, To: Cooper , Lesl ie T., ;.:.. Cc: Windom , John H.; l(b)(G) Short, John (VACO) Subject: RE: [EXTERNAL] RE: VA EHR Call Update I Dr. Cooper - thank you so much. This is incredibly helpful .. Will look forward to discussing at 7:30p m. Hopefully flights are on time - but just let me know if there are any issues and we will adjust. Scott VA-18-0298-I-000601 Page 1231 of 2ib~ of 1380 From: Cooper, Leslie T. , M.D.l(b)(6) ~mayo.edu] Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn, Scott R;.:., .:.... l(b '""" l.,. (6... l ---....-------' Cc: Windom , John HJb )(6) Short, John (VACO) Subject: Re: [EXTERNAL] RE: VA EHR Call Update 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 Gerner system. In my experience using 3 vers ions 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-I-000602 Page 1232 of 2ib~ of 1380 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(bw ~Va .gov>, "Cooper, Leslie T. , M.D." l(b)(6) l(b)(6) mayo.edu> l@va.gov>, "Short, Cc: "Windom, John H." , l(b)(6) John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update I 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 I From:l(b)(6) Sent: Monday , March 19, 20181:38 PM To: Cooper, Leslie T., M.D. 6)___ (b_)(_ Cc: Blackburn , Scott R.; Windom, John H.; 1.... 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 question s. Thanks, Liz From: Cooper, Leslie T. , M.D ..... l(b__ )(_ 6)_____ ___, @mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) 6l____ Cc: Blackburn, Scott R.; Windom , John H.;l...., (b_)(_ ...., Subject: Re: [EXTERNAL] VA EHR Call Update I VA-18-0298-I-000603 Page 1233 of 2ib~ of 1380 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:(b)(6) @va.gov> Date: atur ay , arc , To: "Cooper, Leslie T., M.D.' (b)(6) mayo.edu> Cc; "Blackburn , Scott R.", "Windom , John H.'' , l(b)(6) J@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 Ce11 :l,_ (b_)(6_) ___ __. VA-18-0298-I-000604 Page 1234 of 2ibi of 1380 Document ID: 0.7.1705.1225459 From: Windom , John H. To: Short, John (VACO) ; Blackburn , Scott R. Zenooz, Ashwini ; Draper, Anne ; l(b)(G) 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. Subje ct: RE: VA EHR Call Update On Day one of GoLive we will have the ab ility 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? · l(b)(6) From: Cooper, Leslie T. , M.D.~------~ b~mayo.edu) VA-18-0298-I-000605 Page 1236 of 2ib~ of 1380 Sent: Tuesday, March 20, 2018 4:25 PM To: Blackburn, Scott R;.:..l .;~/= bl=/6=l ====---~ Cc: Windom, John H.; (b)(6) 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 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-I-000606 Page 1237 of 2ibi of 1380 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@va .gov>, "Cooper , Leslie T., M.D.""'-l (b"-')(6 --')__ _, ~ mayo .edu> Cc: "Windom , John H." ,l(b)(6) l@va.gov> , "Short , John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update Mx6) 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(b)(6) Sent: Monday, March 19, 20181:38 PM To : Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R.; Windom , John H.; ..... l(b_)(_6)___ 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) l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) 6l____ Cc: Blackburn , Scott R.; Windom, John H.;..... l(b,.... )(_ ___. Subject: Re: [EXTERNAL] VA EHR Call Update Importance: High I VA-18-0298-I-000607 Page 1238 of 2ib~ of 1380 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) @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper. Leslie T., M.D ."!(bl(6l 1@mayo.edu> Cc: "Blackburn. Scott R.", "Windom, John H." , l(b)(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 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 (b_)(6_) ___ Cell : l._ __. VA-18-0298-I-000608 Page 1239 of 2ibi of 1380 Document ID: 0.7.1705.509672 Windom , John H. Short, John (VACO) To: ; Blackburn, Scott R. Cc: Zenooz, Ashwini ; Draper , Anne ; (b)(6) administrative group (fydibohf23spdlt)/cn=recipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2-truex , matt> Bee: Subject: RE: VA EHR Call Update Date: Tue Mar20 201817 :30 :17 EDT Attachments: 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 Gerner 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 VA-18-0298-I-000609 Page 1240 of 2ibi of 1380 Thoughts? From: Cooper, Leslie T ., M.D.l(b)(6) @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott R.;l(b)(6) l(b.._ )(-6)_____ ____,,I.S-h-ort - ,_John , (VACO) Cc: Windom, John H.; ,....,. 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 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 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 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 examp le, a coronary angiogram report at an outside facility performed in January 2018 should appear in the VA EMR under Cardio logy 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 Federa l 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 cons istent with other feedback you have received from Mayo Clinic experts. VA-18-0298-I-000610 Page 1241 of 2i~i of 1380 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: Monday, March 19, 2018 at 2:39 PM ~ ) l@va.gov>, "Cooper , Leslie T., M.D." ,_l (b_)(_6)__ ~ ~ mayo .edu> Cc: "Windom , John H." , l(b)(6) @va.gov> , "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 I From:l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. (b_)(6 _)___ 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) VA-18-0298-I-000611 Page 1242 of 2i~~ of 1380 From: Cooper, Leslie T. , M.D.l(b)(6) l@mayo .edu] Sent: Saturday, March 17j 2018 9:36 PM To: l(b)(6) l(b_)(_6)____ _. Cc: Blackburn, Scott R.; Windom, John H.; .... Subject: Re: [EXTE RNAL] 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: l(b)(G) l@va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D." l(b)(6) @m ayo.edu> Cc: "Blackburn, Scott R.", "Windom, John H." , l(b)(6) 1@va.gov> Subject: [EXTE RNAL] 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-I-000612 Page 1243 of 2i~~ of 1380 Desk: 202?451-6288 Celt: (We) Page 1244 of2%11%0f 1380 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? From: Cooper, Leslie T ., M.D.l(b)(6) @mayo .edu] Sent: Tuesday , March 20, 2018 4:25 PM To: Blackburn, Scott R.;l(b)(6) Cc: Windom, John H.;,.;..i (b""' )(6 =)=====-========.IS-ho - rt~, 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 Cerner system. VA-18-0298-I-000614 Page 1245 of 2i~i of 1380 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 T : b)(6) va.gov>, "Cooper , Leslie T. , M.D." l(b)(6) (b)(6) @mayo.edu> .____ __, Cc: "Windom, John H." , l(b)(G) @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 VA-18-0298-I-000615 Page 1246 of 2i~~ of 1380 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. 6l____ l(b_)(_ 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, E:J 6)______ From: Cooper, Leslie T. , M.D .._l (b_)(_ -=~mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To :l(b)(6) 5 Cc: Blackburn , Scott R. ; Windom , John H.;l~ (b_)(_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)(G) !@va.gov> Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T., M.D." !iblf6l Cc: "Blackburn, Scott R.", "Windom , John H." , l(b)(6) ~va.gov> VA-18-0298-I-000616 Pa ge 124 7 of 2i ~i of 1380 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 (b_)(S_l __ Cell: ._l ____. VA-18-0298-I-000617 Pa ge 1248 of 2i~~ of 1380 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: Tuesday , 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.o j(b)(G) Sent: Tuesday , March 20, 2018 4:25 PM .:-k= bl~ Da : M M r 1 2 1 2: PM To:(b)(6) va.gov>, "Cooper , Leslie T., M.D." l(b)(6) (b)(6) mayo.edu> ~---~ Cc: "Windom , John H." ,l(b)(6) 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 VA-18-0298-I-000619 Page 1250 of 2i~i of 1380 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_)(_ G)_____ __. From: ._l Sent: Monday , March 19, 20181:38 PM To : Cooper , Leslie T., M.D. .....------. Cc: Blackburn , Scott R.; Windom, John H.; ..... l(b~)(_6l____ 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)(6) @mayo.edu] Sent: Saturda y, March 17, 2018 9:36 PM To: l(b)(6) Cc: Blackburn , Scott R.; Windom, John H.; ..... l(b_)(_6l____ __, 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 l@va.gov> From: l(b)(G) Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D."i(b)(6) @mayo.edu> Cc: "Blackburn, Scott R.", "Windom, John H." , VA-18-0298-I-000620 Page 1251 of 2i1i of 1380 l@va.gov> Subject: [EXTERNAL] VA EHR Call Update l(b)(6) 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 Jb)(G) VA-18-0298-I-000621 Page 1252 of 2i1~ of 1380 Document ID: 0.7.1705.1537739 From: Cooper, Leslie T., M.D. l(b)(6) @mayo.edu> To: Blackburn , Scott R. Cc: Bee: Re: [EXTERNAL] RE : RE: VA EHR Call Update Subject: Tue Mar 20 2018 17:23:44 EDT Date: Attachments: 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 adju st. Scott From : Cooper, Leslie T. , M.o J(b)(G) @mayo .edu] Sent: Tuesday , March 20 , 2018 4:25 PM .,._,. : l(._. b).._ (6,._ ) ---..-------' To : Blackburn , Scott R;..:.. Cc: Windom , John H.:l(b)(6) !Short, 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-I-000622 Page 1253 of 2i1~ of 1380 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-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 Tru sted 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: Monday, March 19, 2018 at 2:39 PM ___. _To:l(§s ) l@va .gov>, "Cooper , Leslie T. , M.D."._l (b_)(_6 )__ ~ mayo .edu> Cc: "Windom, John H." , l(b)(6 ) @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. VA-18-0298-I-000623 Page 1254 of 2i1~ of 1380 Thank you again for the support. Scott I From: l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. (b_)(6 _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 , Liz ...._)(_ 6)_____ ____,__,@mayo.edu] From: Cooper, Leslie T. , M.D . l(b Sent: Saturday, March 17, 2018 9:36 PM ~b- 6---~ To :l(b)(6) Cc: Blackburn , Scott R. ; Windom, John H.; .... I( _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 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.gov> From: j(b)(6) Date: Saturday, March 17, 2018 at 12:13 PM l @mayo.edu> To: "Cooper, Leslie T., M.D." !, "Windom , John H." , l(b)(6) J@va.gov> Subject: [EXTERNAL] VA EHR Call Update VA-18-0298-I-000624 Page 1255 of 2i1i of 1380 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 (b_)(6_) --~ Cell: l~ VA-18-0298-I-000625 Page 1256 of 2i1~ of 1380 Document ID: 0.7.1705.1773946 Blackburn, Scott R. 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. ~b)(6) Sent: Tue sday, March 20 , 2014 :25 PM To: Blackburn, Scott R ·!/b)/6) Cc: Windom, John HJb )(G) 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 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-I-000626 Page 1257 of 2i1i of 1380 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 · (b)(6) @va .gov>, "Cooper , Leslie T. , M.D." l(b)(6) (b)(G) mayo .edu> ,...._ ___ Cc: "Windom, John H." , l(b)(G) John (VACO)" Subject: [EXTERNAL] RE: VA EHR Call Update _. 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(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. Cc: Blackburn , Scott R.; Windom, John H.; (b_)(_6)____ l..... _, VA-18-0298-I-000627 Page 1258 of 2i1~ of 1380 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.o J(b)(G) ~mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To l{bl(6l I 6)___ Cc: Blackburn , Scott R.; Windom, John H.; I...,. (b...., )(,.... _. 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 @va.gov> From: l(b)(G) Date: Saturday, March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T ., M.D ." l{bl(6l Cc: "Blackburn, Scott R.", "Windom, John H." , l(b)(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 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-I-000628 Page 1259 of 2i1i of 1380 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(b)(6) VA-18-0298-I-000629 Page 1260 of 2i1i of 1380 Document ID: 0.7.1705.509640 From: Blackburn , Scott R. 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(b)(6) Sent: Tuesday , March 20 , 2018 4:25 PM To: Blackburn , Scott R.; l(b)(6) Cc: Windom , John H.;""l (b~ )(6~ )......._ ____ S_ho _rt_,__. John (VACO) I__ 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-I-000630 Page 1261 of 2i1i of 1380 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: Monday , March 19, 2018 at 2:39 PM ~) @va .gov>, "Cooper , Leslie T., M.D."l(b)(6 ) (b)(G) mayo .edu> @va.gov>, "Short , Cc: "Windom , John H." l(b)(G) 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 l(b_)(_G______ J From: ...... __, VA-18-0298-I-000631 Page 1262 of 2i1~ of 1380 Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T., M.D. (b_)(_6)___ 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, Liz @mayo.edu] From: Cooper, Leslie T. , M.D. l(b)(S) Sent: Saturday , March 17, 2018 9:36 PM To l(bl(6l I Cc: Blackburn , Scott R. ; Windom, John H.;....,l (b_)(_ 6)____ _. 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: l(b)(6) @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To : "Cooper, Leslie T., M.D." Cc: "Blackburn , Scott R.", "Windom, John H." , Matthew Truex 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-I-000632 Page 1263 of 2i1~ of 1380 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 J(b)(6) VA-18-0298-I-000633 Page 1264 of 2i1~ of 1380 Document ID: 0.7.1705.1773947 From: Blackburn , Scott R. To: Cooper , Leslie T., M.D. l(b)(6) @mayo .ed u> ;,.(b _l,..... )(.6) ..., .,....____ __. Cc: Windom , John H. ; (b)(6) ; Short , John (VACO) Bee: Subject: RE: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 17:12:59 EDT 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 t..aJmayo.edu] From: Cooper , Leslie T ., M.D. l(b)(6) Sent: Tuesday , March 20 , 2018 4:25 PM · !l~b~l lG ~' -------' To : Blackburn, Scott ~~ Cc: Windom , John H.;~b)(S) !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 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 VA-18-0298-I-000634 Page 1265 of 2i1i of 1380 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." Date: Monda March 19 2018 at 2:39 PM 6l__ To : ' (b)(6) va.gov>, "Cooper , Leslie T., M.D." .... l(b_)(_ ...., (b)(6) @mayo.edu> Cc: "Windom , John H." , l(b)(6) 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. VA-18-0298-I-000635 Page 1266 of 2i1~ of 1380 Scott From: .... l(b_)(_6 )_____ _. Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. (b-'-' )(6-')___ 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.o. l(b)(G) @mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) 6)___ Cc: Blackburn , Scott R. ; Windom, John H.; 1...,. ~b ~)(_ __, 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(b_)(_6)________________ ___. Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T., M.D." i(b)(6) @mayo.edu> Cc: "Blackburn , Scott R.", "Windom , John H." , l(b)(6) @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , VA-18-0298-I-000636 Page 1267 of 2i1i of 1380 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)(6) VA-18-0298-I-000637 Page 1268 of 2i1~ of 1380 Document ID: 0.7.1705.509636 Blackburn , Scott R. Cooper , Leslie T., M.D. To: l(b)(6l @mayo .edu>; !(b)(6) Cc: Windom , John H. ; (b)(6) Bee: Subject: RE: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 17:12 :59 EDT Attachments: I Dr. Cooper - thank you so much. This is incredibly helpful .. Will look forward to discus sing 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.DJ(b)(6) @mayo.edu] Sent: Tuesday , March 20, 2018 4:25 PM To : Blackburn , Scott R l(b)(6l Cc: Windom, John H.; lr::" (b77. )(5~)~--,I_ S_h-ort....1 , 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, 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 Gerner system. VA-18-0298-I-000638 Page 1269 of 2i1i of 1380 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 :rop l( 6) @va .gov>, "Cooper , Leslie T., M.D." ~(b)(6) ~ @mayo.edu> .____ _. Cc: "Windom, John H." ,l(b)(S) @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-I-000639 Page 1270 of 2i1i of 1380 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_)(_S)_____ ____. Sent: Monday , March 19, 20181:38 PM To : Cooper , Leslie T., M.D. Cc: Blackburn , Scott R. ; Windom, John H.; ._l (b_)(_6)____ 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_)(_ 6)_____ ------=@mayo.edu] Se 9t: Saturday,March17. 2018 9:36 PM To :l(b)(6) 6)____ Cc: Blackburn , Scott R. ; Windom, John H.;l~ (b_)(_ ~ 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: 1(b)(6) @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T., M.D." l(b)(6) @mayo.edu> Cc: "Blackburn , Scott R.", "Windom , John H." , VA-18-0298-I-000640 Page 1271 of 2i1i of 1380 l(b)(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? 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)(6) VA-18-0298-I-000641 Page 1272 of 2i\~ of 1380 Document ID: 0.7.1705.1225395 From: Cooper, Leslie T., M.D. l(b)(6) @mayo.edu> Blackburn, Scott R. ;~l (b)(6) Windom , John H. ; Truex, Matthew ; 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-I-000642 Pa ge 1273 of 2i\~ of 1380 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 Medicine Mayo Clinic From: "Blackburn, Scott R." Date: Monday, March 19, 20 18 at 2:39 PM ~ ) l@va.gov>, "Cooper , Leslie T. , M.D." l(b)(6) (b)(6) mayo .edu> Cc: "Windom , John H." j(b)(6l @va.gov> , "Short , John (VACO)" Subject: [EXTERNA L] RE: VA EHR Call Update I 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 I From: l(b)(G) Sent: Monday, March 19, 2018 1:38 PM To : Cooper , Lesl ie T., M.D. (b_)(6 _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 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) I From: Cooper, Leslie T ., M.D . rb)(G) @mayo.edu] Sent: Satu rday , March 17, 20 1139:36 PM To :l(b)(6) I 5 Cc: Blackburn, Scott R.; Windom , John H.; ~l (b_)(_ l___ ~ Subject: Re: [EXTERNA L] VA EHR Ca ll Update Importance : High 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 call in as soon as I land? Wednesday I could make a call after 6:30 pm. Leslie From:l(b)(G) l@va .gov> Date: Saturday , March 17, 2018 at 12:13 PM To: "Cooper, Lesl ie T., M.D. "!{b}/6} @mayo .edu> Cc: "Blackburn , Scott R.", "Windom , John H." , l(b)(6) @va.gov> VA-18-0298-I-000643 Pa ge 1274 of 2i \~ of 1380 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 aQain! (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) I VA-18-0298-I-000644 Page 1275 of 2i1i of 1380 Document ID: 0.7.1705.509447 From: Cooper, Leslie T., M.D. !iblf6l l@mayo.edu> To: Blackburn, Scott R. ; l._ (b)(6) ; (b)(6) ; Short , John (VACO) Bee: Subject: Re: [EXTERNAL] RE: VA EHR Call Update Date: Tue Mar 20 2018 16:25:09 EDT 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 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 VA-18-0298-I-000645 Pa ge 1276 of 2i\~ of 1380 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 rev iewed 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 l(b_)(_6)__ __, To: (b)(6) @va .gov>, "Cooper, Leslie T., M.D." .... (b)(6) mayo .edu> Cc: "Windom, John H." , l(b)(6) l@va.gov>, "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 cove r that issue from 7:30-8pm ET before others join at 8pm. Thank you again for the support. Scott I From: l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper , Leslie T. , M.D. 5 Cc: Blackburn , Scott R.; Windom, John H.; ._ (b_)(_ l____ Subject: RE: [EXTERNAL] VA EHR Call Update I _. 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) I 6l________ From: Cooper, Leslie T. , M.D ..... l(b_)(_ @mayo .edu] Sent: Saturday, March 17, 2018 9:36 PM I To: l{b)(6) 6)___ Cc: Blackburn , Scott R.; Windom, John H.:l.... (b_)(_ ~ 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 VA-18-0298-I-000646 Page 1277 of 2i1iof 1380 From: l(b)(6) @va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D ."l(b)(6) l@mayo.edu> Cc: "Blackburn , Scott R.", "Windom, John H." , l(b)(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 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 aaain! (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)(6) I VA-18-0298-I-000647 Page 1278 of 2i\~ of 1380 Document ID: 0.7.1705.1225173 From: VAC IO Executive Schedule To: Windom, John H. ; Blackburn , Scott R. ; ._l _.. (b_)(_ ; Carolyn@Bruce @gmail.com> ; Bruce Moskowitz Moskowitz.MD tlbl/5l l(b)(6) l@mac .com> Cc: Bee: Canceled: EHR VA Call Subject: Tue Mar 20 2018 12:33:29 EDT Date: Attachments: VA-18-0298-I-000648 Page 1279 of 2i1i of 1380 Document ID: 0.7.1705.1773132 From: Blackburn, Scott R. To: DJS ; Windom, John H. ; Zenooz, Ashwini ; Short, John (VACO) ; Bruce Moskowitz (b)(6) @mac.com>; Marc Sherman l(b)(6l l@gmail.com> Cc: (b)(6) Bee: EHR calls tomorrow night Subject: Date: Mon Mar 19 2018 21 :55:27 EDT Attachments: (b_)(_s)________ We will start at 7:30pm tomorrow night. Dial in is: ._l __, 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-I-000649 Page 1280 of 2i1i of 1380 Document ID: 0.7.1705.508899 Blackburn , Scott R. DJS ; Windom, John H. ; Zenooz, Ashwini ; Short, John (VACO) ; 5189-short, john>; Bruce Moskowitz l(b)(6) Marc Sherman l(b)(6) !@gmail.com> Cc: l(b )(6) Bee: Subject: EHR calls tomorrow night Date: Mon Mar 19 2018 21 :55:27 EDT Attachments: I We will start at 7:30pm tomorrow night. Dial in is: ~l (b_)(_G)________ ~ 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-I-000650 Page 1281 of 2iY6 of 1380 Document ID: 0.7.1705.1224124 Bn ,ce Moskowitz From: l(b)(G) @mac.com> To: Blackburn , Scott R. Marc Sherman l(b)(6) @qmail.com> ; Cc: Windom , John H. ; (b)(6) /o=va/ou=exchange 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 join s at 8pm ET. I think we will have everyone except Stan Huff and Dr. Ko on the call. Liz is working a time on Wednesday to get them on a call. Scott From: Blackburn, Scott R. Sent: Monday, March 19, 2018 2:40 PM To : (b)(6) Coo er Leslie T ., M.D. Cc: Windom , John H.;(b)(6) 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-I-000651 Page 1282 of 2i~ of 1380 Scott I From: l(b)(6) Sent: Monday, March 19, 20181:38 PM ~-----~ To: Cooper , Leslie T. , M.D. 6l____ Cc: Blackburn , Scott R.; Windom, John H.;,....l (b_)(_ 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) l@mayo.edu] Sent: Saturday , March 17, 2018 9:36 PM To: l(b)(6) I Cc: Blackburn , Scott R.; Windom, John H.J,_ (b_)(_6)____ _. 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: l(b)(6) l@va.gov> Date: Saturday , March 17, 2018 at 12:13 PM @mayo.edu> To: "Cooper, Leslie T., M.D." l(b)(6) Cc: "Blackburn, Scott R.", "Windom , John H." , l(b)(6) @va.gov> Subject: [EXTERNAL] VA EHR Call Update Good afternoon Dr. Cooper , VA-18-0298-I-000652 Pa ge 1283 of 2i~ of 1380 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 l(b_)(6 _)___ Cell: ..... ....., VA-18-0298-I-000653 Page 1284 of 2i~ of 1380 Document ID: 0.7.1705.1772937 From: Blackburn, Scott R. Bruce Moskowitz To: l(b)(6) @mac .com>; Marc Sherman l(b)(6) @gmail.com> Cc: Windom , John H. ; ~b)(G) ~/o=va/ou=exchange 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. Liz is 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 : (b)(6) Coo er, Leslie T. , M.D. Cc: Windom, John H.; (b)(6) 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 I From:l(b)(6) Sent: Monday, March 19, 20181:38 PM .-------. To: Cooper , Leslie T., M.D. Cc: Blackburn , Scott R.; Windom, John H.;..... l(b_)(_6l___ Subject: RE: [EXTERNAL] VA EHR Call Update ___, VA-18-0298-I-000654 Page 1285 of 2iYa of 1380 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, Liz 6)______ From: Cooper, Leslie T., M.D .._l (b_)(_ =tymayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) Cc: Blackburn, Scott R. ; Windom, John H.;~l (b_)(6 _)___ ~ Subject: Re: [EXTERNAL] VA EHR Call Upda te 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 @va.gov> From: l(b)(S) Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Lesl ie T ., M.D.' l Cc: "Blackburn , Scott R.", "Windom, John H." , l(b)(6) l@va.gov> SubJect: [EXTERNAL] VA EAR 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-I-000655 Page 1286 of 2iYs of 1380 (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202 -461 -6288 l(b_)(6 _)____ Cell : ..... _, VA-18-0298-I-000656 Page 1287 of 2i~ of 1380 Document ID: 0.7.1705.508064 From: Blackburn , Scott R. To: Bruce Moskowitz @mac.com>; Marc Sherman !~(b_J(_6l__ ~ @gmail.com> l(b)(6) Windom , John H. Cc: ; l(b)(6) 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. l(b)(6) is working a time on Wednesday to get them on a call. I Scott From: Blackburn, Scott R. Sent: Monda March 19 2018 2:40 PM To:(b)(6) 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. Scott I From: l(b)(6) Sent: Monday, March 19, 20181:38 PM To: Cooper, Leslie T., M.D. l(b_)(_6l____ Cc: Blackburn , Scott R.; Windom , John H.;.... ..., VA-18-0298-I-000657 Page 1288 of 2im, of 1380 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)(S) l@mayo.edu] Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6 ) Cc: Blackburn , Scott R.; Windom, John H.; -l(b_)(_6l____ ~ 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)(S) l@va.gov> Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper, Leslie T ., M.D ."!(b)(6) @mayo.edu> Cc: "Blackburn, Scott R.", "Windom, John H." , l(b)(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 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-I-000658 Page 1289 of 2iYs of 1380 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 (b_)(S _) ___ __, VA-18-0298-I-000659 Page 1290 of 2i~ of 1380 Document ID: 0.7.1705.508053 From: Blackburn , Scott R. l(b)(6) l; Cooper, Leslie T., M.D. (b)(6) mayo.edu> Windom , John H. ; (b)(6) ; Short, John (VACO) Bee: Subject: RE: [EXTERNAL] VA EHR Call Update Date: Mon Mar 19 2018 14:39:52 EDT 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 l(b_)(_6)_____ ___, From: .... Sent: Monday, March 19, 2018 1:38 PM .--------. To: Cooper , Leslie T. , M.D. 6 ___ Cc: Blackburn , Scott R. ; Windom, John H.:!.... (b_)(_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 . .... i(b_)(_6)______ Sent: Saturday, March 17, 2018 9:36 PM To: l(b)(6) ~mayo.edu] I VA-18-0298-I-000660 Page 1291 of 2i1i of 1380 Cc: Blackburn , Scott R.; Windom, John H.; l._ (b_)(6 _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 @va.gov> From: l(b)(6) Date: Saturday, March 17, 2018 at 12:13 PM To: "Cooper , Leslie T ., M.D." l(b)(6) @mayo.edu> Cc: "Blackburn, Scott R.", "Windom, John H." , l(b)(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 Cell : l(b)(6) VA-18-0298-I-000661 Page 1292 of 2i1~ of 1380 Document ID: 0.7.1705.1356917 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; Blackburn, Scott R. ; Windom, John H. ;.... (b)(6) ; Bruce Moskowitz l(b)(6) ]@ mac.com> ; Carolyn@Bruce Moskowitz M~ !(b)(6) @gmail.com>; Marc Sherman l(b)(G) ~gmail.com>; 1PE:)@ frenchangel59.com>; Foster , Michele (SES) ; Nostrant, David K. ; Draper , Anne ; Zenooz , Ashwini ; Short, John (VACO) ; Myklegard, Drew ; .... !{b)(6) f /o=va/ou=exchange administrative group (fydibohf23s dlt /cn=recipients/cn=vacocallae2>; Cooper, Leslie T., M.D. (b)(6) mayo .edu> Cc: Bee: VA EHR Call Subject: Mon Mar 19 2018 13:32 :31 EDT Date: Attachments: StartTime: Tue Mar 20 18:30:00 Central Daylight Time 2018 EndTime: Tue Mar 20 19:00:00 Central Daylight Time 2018 Location :l(b)(G) Invitees: Blackburn , Scott R. ; Windom, John H.; l(b)(G) !Bruce Moskowitz ; 'Carolyn@Bruce Moskowitz .MD'; Marc Sherman; IP; Foster, Michele SES ; Nostrant , David K.; Draper , Anne; Zenooz, Ashwini; Short, John (VACO) ; Myklegard, Drew; (b)(6) Cooper, Leslie T., M.D. 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 partic ~ get feedback from Dr. Cooper. Thanks ,~ Scheduling POC: l._ (b_)(G _) __ n the entire session so we are going to start at 7:30PM to ___.l 2o2-631-0640 l._ (b_)(G _)____ _. @va.gov VA-18-0298-I-000662 Page 1296 of 2i1~ of 1380 Document ID: 0.7.1705.1223600 VAC IO Executive Schedule From: Blackburn, Scott R. ; Windom, John H. ; l(b)(6) !{b)(6) j::/o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm> ; Bruce Moskowitz ! ; Carolyn@Bruce @gmail.com> ; Marc Sherman Moskowitz .MD j(b)(6) l(b)(6) @gmail.com>; l~frenchangel59.com>; Foster , Michele (SES) ; Nostrant , David K. ; Draper , Anne ; Zenooz, Ashwini ; Short, John (VACO) ; Myklegard , Drew ; ~l (b)(6) ; Cooper, Leslie T., M.D. (b)(6) mayo .edu> Cc: Bee: Subject: VA EHR Call Date: Mon Mar 19 2018 13:32:29 EDT Attachments: I All, Dr. Cooper will not be able to partici ate in the entire session so we are going to start at 7:30PM to get feedback from Dr. Cooper . Thanks (b)(6) Scheduling POc: l(b)(G) I202-631-064 tj(b)(6) @va.gov VA-18-0298-I-000663 Page 1297 of 2i1~ of 1380 Document ID: 0.7.1705.1772560 From: Blackburn , Scott R. To: Marc Sherman !(b)(6l @qmail.com>; Bruce Moskowitz (b)(6) mac .com> Cc: (b)(6l Bee: Subject: RE: [EXTERNAL] Re: FW: VA EHR Call Date: Mon Mar 19 2018 08:40:55 EDT Attachments: 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 walk you through how to read the government contract (which is guys (John Windom j(b)(6) 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-I-000664 Page 1298 of 2i1i of 1380 5 l_____ From: ._l (b_)(_ _. 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(b)(6) I -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday , March 15, 2018 [i1 ·23 AM Blackburn , Scott R. ; Windom, John H.; To : VACIO Executive Schedule ; (b)(S) Carolyn@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(b)(6) I I VA-18-0298-I-000665 Page 1299 of 2i1~ of 1380 Document ID: 0.7.1705.506207 From: Blackburn, Scott R. Marc Sherman (b)(6) mail.com>; To: Bruce Moskowitz (b)(6) mac.com> b 6 Cc: Bee: Subject: RE: [EXTERNAL] Re: FW: VA EHR Call Date: Mon Mar 19 2018 08:40:55 EDT Attachments: 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 guys (John Windom,l(b)(6) 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-I-000666 Page 1300 of 2i1iof 1380 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 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(b)(6) I -----Original Appointment----From: VAC IO Executive Schedule Sent: Thursday, March 15, 2018 11 :23 AM To : VACIO Executive Schedule J(b)(6l Blackburn , Scott R. ; Windom, John H.; Carolyn@Bruce Moskowitz.MD; Marc Sherman; Bruce Moskowitz Subject: VA EHR Call When : Monda y, March 19, 2018 12:00 PM-12:45 PM (UTC-05:00) Eastern Time (US & Canada) . Where :l(b)(6l I I VA-18-0298-I-000667 Page 1301 of 2i1~of 1380 Document ID: 0.7.1705.1530986 From: @gma il.com> Marc Sherman i(b)(6) Blackburn, Scot R. ; Bruce Moskowitz l(b)(6) @mac.com> 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, l(b)(6) 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)(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. Br e and Marc Sherman for the contract overview. Do you want to keep it or can I cancel it? Thanks, (b)(6) -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday, March 15, 2018 ..,_,_........_L..l,,U .____~ 6 To: VACIO Executive Schedule ; (b)( ) Blackburn , Scott R.; Windom, John H.; Carolyn@Bruce Moskowitz.MD; arc ruce 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-I-000668 Page 1302 of 2i1i of 1380 Where: (We) Page 1303 01?29616g0f 1380 Document ID: 0.7.1705.505892 From: Blackburn, Scott R. (b)(6) /o=va/ou=exchange To: a min1strat1vegroup (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> 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 6 )_______ From: Bruce Moskowitz ~l (b_)(_ Sent: Sunday , March 18, 2018 4:58 PM To: Blackburn, Scott R. (b-)(-6)------~ 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, l(b)(6 ) 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 From: l(b)(G) Sent: Sunday , March 18, 2018 2:36 PM 0 VA-18-0298-I-000670 Page 1304 of 2iWJ of 1380 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, Liz -----Original Appointment ----From: VAC IO Executive Schedule Sent: Thursday, March 15, 2018 11:23 AM Blackburn , Scott R.; Windom, John H.; To: VACIO Executive Schedule ;i{b)(G) Carolyn@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(b)(6) I I VA-18-0298-I-000671 Page 1305 of 2i1A of 1380 Document ID: 0.7.1705.1530107 Bruce Moskowitz From: l(b)(6) @mac .com> Blackburn , Scott R. Marc Sherma rl(b)(6) @gmail.com> ; Cc: Callaghan, Elizabeth 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, l(b)(6) 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_)(_G)______ _, 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(b)(6) I -----Original Appointment----From: VACIO Executive Schedule Sent: Thursday, March 15, 2018 11 :23 AM Blackburn , Scott R. ; Windom, John H.; To: VACIO Executive Schedule: l(b)(6) Carolyn@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(b)(6) I I VA-18-0298-I-000672 Page 1306 of 2i~ of 1380 Document ID: 0.7.1705.1772156 From: Blackburn, Scott R. To: Marc Sherman (b)(6) mail.com>; Bruce Moskowitz (b)(6) mac.com> Cc: (b)(6) 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 guys (John Windom, l(b)(6) walk you through how to read the government contract (which is 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, l(b)(6) I -----Original Appointment----From: VA CIO Executive Schedule Sent: Thur sday, March 15, 2018 11 :23 AM Blackburn , Scott R. ; Windom, John H.; To: VACIO Executive Schedule ;l(b)(6) Carolyn@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(b)(6) I I VA-18-0298-I-000673 Page 1308 of 2i'% of 1380 Document ID: 0.7.1705.505886 From: Blackburn, Scott R. Marc Sherman (b)(6) gmail.com>; To: Bruce Moskowitz (b)(6) mac.com> (b)(6) Cc: Blackburn, Scott R. Cc: Bee: Subject: RE: VA EHR Call Date: Sun Mar 18 2018 14:35:50 EDT Attachments: 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(b)(6) I -----O riginal Appointment ----From: VACIO Executive Schedule Sent: Thursday , March 15, 2018 11 :23 AM Blackburn , Scott R. ; Windom , John H.; To: VACIO Executive Schedule ;l(b)(6) Carolyn@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(b)(6) I I VA-18-0298-I-000675 Page 1310 of 2i1/s of 1380 Document ID: 0.7.1705.1222417 VAC IO Executive Schedule From: Blackburn, Scott R. ; Windom, John H. ; 1._ (b)(G) /o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm>; Bruce Moskowitz ; Carolyn@Bruce @gma il.com>; Marc Sherman Moskowitz MD l(b)(G) 5 frenchangel59.com>; Stephanie ) (b)(G) gmail.com>; 1pcb)C Reel (b)(G) jhu.edu> ; Mary 1or b 6 u>; Ashley Johnson (b)(G) jhmi.edu>; .__ (b)(G) _. ; Rasu Shrestha '--,-:-:--:-:--:-:---,....---J =g mail.com >; Manis , Jonathan (Jon) sutterhealth.org>; Shrestha, Rasu B ',------'-:::........, @upmc.edu>; Cooper, Leslie T., M.D. r::-':",~'------=1 .-: ........... ~-,____,. ~ mayo.edu >; Karson, Andrew Scott,M.D . (b)(G) @mgh.harvard.edu>; Zuccala, Kandace (Kandi) R. (b)(G) sutterhealth.org> facs.org>; Mehwe sh Cc: Clifford Ko ~ @facs.org >; Stan Huff l,_ (b-)(-6)-~ @imail.org > Khalid l(b)(G) Bee: VA EHR Call Subject: Sun Mar 18 2018 14:31:22 EDT Date: Attachments: ______ Scheduling POC : ._l (b-)(_ GJ__ _..l 202-631-0640 an~._ (b_)(_G )_____ ..... @va.gov All, I am including everyone in the group in case anyone has any last minute scheduling changes. Thanks, ~ VA-18-0298-I-000676 Pag e 1311 of 2i'% of 1380 Document ID: 0.7.1705.1356907 VAC IO Executive Schedule From: VACIO Executive Schedule To: ; Blackburn, Scott R. ; Windom, John H. ;I(b)(6) l(b)(6) l; Bruce Moskowitz( b)(6) mac.com>; Carolyn@Bruce Moskowitz .MD (b)(6) mail.com> ; Marc Sherman (b)(6) gmail.com>; I (b)(6 fr;,,,,..,..,.;.........,......,."" I59.com>; Stephanie ee (b)(6) jhu.edu> ; Mary Riordan (b)(6) 'hu.edu> ; Ashley Johnson (b)(6) jhmi.edu>; ,,__ (b)(6) ; Rasu Shrestha (b)(6) gmail.com>; Manis , Jonathan (Jon) (b)(6) sutterhealth.org>; Shrestha, Rasu B p.;;;.,.i ..a.,..... __ ........., ,upmc.edu>; Cooper, Leslie T., M.D. lr.":':::-;--,..____J~mayo.edu >; Karson , Andrew Scott,M.D. 1---~mgh .harvard.edu> ; Zuccala, Kandace (Kandi) R. (b)(6) sutterhealth.org> Clifford Ko (b)(6)@facs.org >; Mehwesh Cc: .... -)(6 - )----. ~imail.org > Khalid (b)(6) facs.org >; Stan Huffl,(b 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 EndTirner I ,,e Mac 20 2Q·3Q·QQCeofral Dayl ight Time 2018 Location l(b)(S) . !Bruce Moskowitz ; 'C r I n lnvitees :L.. B-la_c_k_b_ ur_n_, _S_co _ t_t _R__;- W - in_d__, om, John H.;~b)(S) 6)__ (b_)(_ ~ Moskowitz .MD'; Marc Sherman; IP; Stephanie Reel ; Mary Riordan; 'Ashley Johnson'; ,._ l(b)(6) '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 ! Scheduling POC J..... (b_)(6 _)__ All, I am includin ~l 202-631-0640 and l(b ..... _)(6 _) ____ __,~va .gov everyone in the group in case anyone has any last minute scheduling changes. Thanks, (b)(6) '---~ VA-18-0298-I-000677 Page 13 14 of 2i117 of 1380 Document ID: 0.7.1705.505780 From: Blackburn , Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re : VA EHR call Date: Sun Mar 18 2018 14:19:24 EDT Attachments: Yes please From J~ (b_)(_G)_ ____ ~ Sent: Sunday, March 18, 2018 2:18 PM To: Blackburn, Scott R. Subject: RE : [EXTERNAL] Re: VA EHR call Yes, I think that will work. I am going to invite everyone just in case folks have last minute changes to their schedules. Do we want to do 90 minutes? From: Blackburn, Scott R. Sent: Sunday, March 18, 2018 2:17 PM To: l(b)(G) Subject: RE : [EXTERNAL] Re : VA EHR call Importance : High I Yes, let's do it. I know Stan Huff can't join. Perhaps we have a second call on Wednesday for anyone who couldn't join. I From: l(b)(G) Sent: Sunday, March 18, 2018 2:16 PM To: Blackburn , Scott R. Subject: FW: [EXTERNAL] Re: VA EHR call VA-18-0298-I-000678 Pa ge 1316 of 2i1/s of 1380 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 , liz .... _)(_6 )_______ From: Bruce Moskowitz l(b Sent: Sunday, March 18, 2018 1:50 PM To : Blackburn, Scott R. Cc: Marc Sherman; ~l(b-)(-6)-----~ Subject: [EXTERNAL] Re: VA EHR ca ll __.@.mac.com] 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 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 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 l(b_)(_6)_____ __. From: .... 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-I-000679 Page 1317 of 2i'% of 1380 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: Saturday, March 17, 2018 2:28 PM To : !ibll6l I Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High O 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(b)(6) I I Cc: Blackburn , Scott R. ; l(b)(6) Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Deaf H5l 11 am participating in a ceremony at 630 pm on Tuesday , but I could be on the VA call any time VA-18-0298-I-000680 Page 1318 of 2i1iof 1380 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(b)(6) l@va.gov] Sent: Saturday, March 17, 2018 12: 15 PM To: Karson, Andrew Scott,M.D. l(b)(6) @mgh.h~a=r"""' va=r....:;; d"-' .e'-" d=u'->______ Cc: Blackburn, Scott R. ; l(b)(6) 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 . Th a nks again! l(b)(6) From: Karson, Andrew Scott,M.D J(b)(6) l@mgh.harvard.edu] Sent: Friday, March 16, 2018 7:22 PM To j(b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dea rl(b)(6~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 From: l(b)(6) l@va.gov] Sent: Friday, March 16, 2018 7:12 PM To: Stan Huff l(b)(6) @ imai l.org>; Cooper, Leslie T., M.D. !/b)(6) @ mavw edu>; Karson, Andrew Scott,M.D. (b)(6) mgh.harvard.edu>; Shrestha, Rasu s l(b)(G) @upmc.edu>; Rasu Shrestha (b)(6) gmail.com> VA-18-0298-I-000681 Page 13 19 of 2i1~of 1380 Cc· BlackburnScottR ; Windom , John H. ; J(b)(6) l(b)(6) @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) I From: l(b)(6) Sent: Friday, March 16, 2018 1:0gM To : 'Stephanie Reel' ; 'Stan Huff';~ facs .org'; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott,M.D.'; 'Shrestha, Rasu B'; 'Rasu Shrestha' ·Bruce Moskowitz'; 'Caro lyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6l Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling 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 schedu le. Please feel free to call me with any questions. Thank you , l(b)(6) From: ~.... (b_..) (_,_6) _____ __, Sent: Thur sday, 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; 'Carolyn @Bruce Cc: Blackburn , Scott R. ; Windom, John H.:l(b)(6) Moskowitz .MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR I VA-18-0298-I-000682 Page 1320 of 2i1~ of 1380 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)(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-I-000683 Page 1321 of 2i1~ of 1380 Document ID: 0.7.1705.1530082 From: l(b)(G) 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 will work . I am going to invite everyone just in case folks have last minute changes to their schedules. Do we want to do 90 minutes? From: Blackburn, Scott R. Sent: Sunday , March 18, 2018 2:17 PM To:l(b)(6) Subject: RE: [EXTERNAL] Re : VA EHR call Importance : High I Yes , let's do it. I know Stan Huff can 't join . Perhap s we have a second call on Wednesday for anyone who couldn't join . From J~ (b_)(_6)_____ ~ 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(b)(6 )I From: Bruce Moskowitz .... l(b-)(~6 )~~-------' Sent: Sunday , March 18, 2018 1:50 PM To: Blackburn, Scot.... t '--' R..... . --------, Cc: Marc Sherman: l.._ (b_)(_6)_____ _____. Subject: [EXTERNAL] Re: VA EHR call l@mac.com] VA-18-0298-I-000684 Page 1322 of 2i1i of 1380 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(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. VA-18-0298-I-000685 Page 1323 of 2i1~ of 1380 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 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: Saturda , March 17, 2018 2:23:32 PM To : b 6 Cc: Blackburn, Scott R. ; (b)(S) Windom , John H. Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Dearl(bl(6l II 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 6l______________ From:~l (b_)(_ Sent: Saturday , March 17, 2018 12: 15 PM ~l @va .gov] VA-18-0298-I-000686 Page 1324 of 2i1i of 1380 To: Karson, Andrew Scott,M.D. l(b)(G) @mgh .h~a_rv_a_r_d _ .e_d_u_>______ Cc: Blackburn , Scott R. ; l(b)(6) 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 Tue sday 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)(G) @mgh.harvard .edu) Sent: Friday, March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dearl(b)(G* 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 only time among those three that I can do is the Tu esday 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 Froml(b)(G) @va .gov) Sent: Friday , March 16, 2018 7:12 PM To : Stan Huff b 6 imail.org>; Cooper, Leslie T., M.D.l(b)(6) @mayo .edu> ; Karson , 1@upmc .edu> ; Andrew Scott ,M.D. (b)(6) mgh.harvard.edu>; Shrestha , Rasu B l(b)(6) Rasu Shrestha (b)(6) gmail.com> Cc: Blackburn , Scott R. ; Windom , John H. ; l(b)(G) l(b)(6) ~va.gov> Subject: RE: Scheduling a Call Regard ing Feedback on VA EHR Importance : High • 0 Good evening , VA-18-0298-I-000687 Page 1325 of 2i1~ of 1380 Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening , LJ From: ~l (b_)(G _) _____ ~ Sent: Friday, March 16, 20181:06 PM To: 'Stephanie Reel'; 'Stan Huff'~~)(~l l@facs.org'; 'Cooper , Leslie T. , M.D.'; 'Karson, Andrew Scott ,M.D.' ; 'Shrestha, Rasu B'; 'Rasu Shres a ·Bruce Moskowitz'; 'Caro lyn@Bruce Cc: Blackburn , Scott R.; Windom, John H.;l(b)(G) Moskowitz.MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling 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 , ~ I From:l(b)(6) Sent: Th ursday, 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' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R.; Windom, John H.;j(b)(6) Moskowitz ,MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Schedu ling a Call Regarding Feedback on VA EHR 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 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 w ith any questions and I look forward to hearing from you. VA-18-0298-I-000688 Page 1326 of 2i1i of 1380 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-I-000689 Page 1327 of 2i1i of 1380 Document ID: 0.7.1705.505774 From: Blackburn , Scott R. To: l(b)(6) l 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 join . Perhaps we have a second call on Wednesday for anyone who couldn 't join . From:,....l (b_)(_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 Tuesday at 8PM. It looks like Dr. Cooper can now join for the first half of the call. Thanks , liz From: Bruce Moskowitz ,....l (b~)(~6)_______ Sent: Sunday , March 18, 2018 1:50 PM To : Blackburn, Scott R. Cc: Marc Sherman ; ,..,.l (b-)(,6) ..,.., --------, Subject: [EXTERNAL] Re: VA EHR call ~ @mac.com] 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 VA-18-0298-I-000690 Page 1328 of 2i1i of 1380 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) 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 ... VA-18-0298-I-000691 Page 1329 of 2i1~ of 1380 From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 2:28 PM I To: l(b)(6l 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: Saturday, March 17, 2018 2:23:32 PM ~ To :l(b)(6) Cc: Blackburn , Scott R.; (b)(6) !Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dear l(b)(611am 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(b)(6) @va.gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott,M.D. l(b)(6) @mgh.h,... a.... c~-a ..... rd....e .... d...u._>______ Cc: Blackburn , Scott R. ; l(b){sj: 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 confirming Tuesday works best for you . If we started the call later in the evening, VA-18-0298-I-000692 Page 1330 of 2i1~of 1380 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.OJ(b)(6) @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 Dea~(b)(6llso 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 6 From: .... lfb~)(~)_~~-~-~~ -----~ @va .gov] Sent: Friday , March 16 20187:12 PM ,.,,...,.,-:-,------, To: Stan Huff (b)(6) imail.org>; Cooper, Leslie T., M.D.L(b..:...: )(....:.6 )_ ___...---- =.:..:..=..Li Andrew Scott ,M.D (b)(6) mgh.harvard .edu >; Shrestha , Rasu B (b)(6) upmc .edu> ; Rasu Shrestha l(b)(6l @gmail.com> (b_J(_5l_ __. Cc· Blackburn Scott R ; Windom , John H. ._j La2va.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, (b_)(_ 6)_____ __. From: ._l Sent: Friday, March 16, 20181:06 PM facs .org'; 'Cooper , Leslie T., M.D.'; 'Karson , Andrew Scott ,M.D.' ; To: 'Stephanie Reel'; 'Stan Huff ; ~ VA-18-0298-I-000693 Page 1331 of 2i1~of 1380 'Shrestha, Rasu B'; 'Rasu Shrestha' ·Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.: l(b)(G) 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) 5 )_____ ~ From:~l (b_)(_ 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': 'Ras u Shrestha' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(G) 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 VA-18-0298-I-000694 Page 1332 of 2i1i of 1380 US Department of Veterans Affairs Desk: 202-461-6288 Cell :l~ (b_)(G _) ----~ 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-I-000695 Page 1333 of 2i1~of 1380 Document ID: 0.7.1705.1530063 _l (b_)(_6 )_____ ~I Blackburn, Scott R. Cc: Bee: Subject: FW: [EXTERNAL] Re: VA EHR call Date: Sun Mar 18 2018 14:16:00 EDT Attachments: 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 , liz From: Bruce Moskowitz ._l (b~)(~5l_______ Sent: Sunday , March 18, 2018 1:50 PM To: Blackburn, Scott,.... R ;_;,,;_ . -----~ Cc: Marc Sherman; l._ (b_)(_6 )_____ _____, Subj ect: [EXTERNAL] Re: VA EHR call _____, @ma c.com] 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 call, on the call at that time . Thanks again for the help, Scott VA-18-0298-I-000696 Page 1334 of 2i1iof 1380 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 (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 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 ... LJ From: Blackburn, Scott R. Sent: Saturday , March 17, 2018 2:28 PM To j(b)(6) 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. VA-18-0298-I-000697 Page 1335 of 2i1~of 1380 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. (b)(6) Windom , John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR 5 Dea rl<>h 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(b)(6) l@va.gov] Sent: Saturday, March 17, 2018 12:15 PM To : Karson, Andrew Scott,M.D. l(b)(6) @mgh.h -a_rv_a_rd _ ._e_d_ u> _______ Cc: Blackburn , Scott R. : l(b)(6) Windom , John H. Subject: RE : Scheduling a Call Regard ing 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. l(b)(S) @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 VA-18-0298-I-000698 Page 1336 of 2i1iof 1380 5 Dead(bl< l 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 From: l(b)(6) @va .gov] Sent: Friday , March 16, 2018 7:12 PM To : Stan Huff (b)(6) imail.org>; Cooper, Leslie T., M.D. (b)(G) .edu>; Karson, Andrew Scott,M.D. (b)(6) mgh.harvard.edu>; Shrestha, Rasu B (b)(G) upmc.edu>; Rasu Shrestha (b)(6) @gmail.com> l(b_)(_6l_ __, Cc: Blackburn. cott R. < cott.Blackburn@va.gov>; Windom , John H. ; .... 6 l(b)( ) @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) From:l(b)(G) 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' tBruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn, Scott R. ; Windom, John H.l(b)(6) Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling a Call Regarding Feedback on VA EHR Importance : High 0 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. VA-18-0298-I-000699 Page 1337 of 2i1iof 1380 Thank you , ~ I From: l(b)(5) 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 , Rr• 1B'· 'Ras11Shr , stha' Cc: Blackburn , Scott R. ; Windom, John H_{b )(6lBruce Moskowitz; 'Carolyn@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 Ce11 :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-I-000700 Page 1338 of 23rbi of 1380 Document ID: 0.7.1705.1530058 Bruce Moskowitz From: l(b)(6) @mac.com> To: Blackburn, Scott R. @gmail.com> ; Marc Sherman b s Cc: (b)(6) Bee: Subject: [EXTERNAL] Re: VA EHR call Date: Sun Mar 18 2018 13:50:25 EDT Attachments: 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_)(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-I-000701 Page 1340 of 23rb~ of 1380 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) 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 folk s)? 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-I-000702 Page 1341 of 23rb~ of 1380 To (b)(6) Cc: Blackburn , Scott R.; (b)(6) Windom, John H. Subject: [EXTERNAL] RE: Scheduling 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 From:l(b)(G) @va .gov] Sent: Saturday, March 17, 2018 12:15 PM @mgh.h~a_rv_a_r_d _ .e_d_u_>______ To: Karson, Andrew Scott ,M.D.l(b)(6) Cc: Blackburn , Scott R. ;l(b)(6) 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 everyon e. Thank s again! r b)(6) From: Karson , Andrew Scott ,M.D J(b)(6) l@mgh.harvard .edu] Sent: Friday , March 16, 2018 7:22 PM To :l(b)(6) Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dearl(b)(GJ 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-18-0298-I-000703 Page 1342 of 23rb~ of 1380 From fb )(5 ) @va .gov] Sent: Friday, March 16, 2018 7:12 PM To: Stan Huff l(b)(6) @imail.org>; Cooper, Leslie T., M.D. '-'(b..:....: )(.....: 6)_ _,.----"' =.:....:.=...., Andrew Scott,M.D . (b)(6) @mgh.harvard.edu>; Shrestha , Rasu B (b)(6) @upmc .edu> ; Rasu Shrestha( b)(6) @gmail.com> Cc: Blackburn, cott . < cott.Blackburn@va.gov>; Windom , John H. ; ~ 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, l(b)(6) I From: l(b)(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' Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(5 ) l'Bruce Moskowitz'; 'Carolyn@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 schedule. Please feel free to call me with any questions. Thank you , l(b)(6) From: ~l (b_)(_ 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' VA-18-0298-I-000704 Page 1343 of 23rbi of 1380 l Cc: Blackburn , Scott R.; Windom, John H.j(b)(G) Bruce Moskowitz; 'Carolyn@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 (b-)(6 _)___ Cell : l~ ~ 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-I-000705 Page 1344 of 23rb~ of 1380 Document ID: 0.7.1705.1529943 From: Marc Sherman l(b)(6) @gmail.com> To: Blackburn, Scott R. Cc: Bruce Moskowitz l(b)(6) lcv,mac.com>;._l (b_)(6 _)_____ 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, "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(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 VA-18-0298-I-000706 Page 1345 of 23rbi of 1380 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 .. . LJ From: Blackburn, Scott R. Sent: Saturda~ March 17 2018 2:28 PM :~XI To: l(b)(6) ERNA:1 RE: Scheduling a Call Regarding Feedback on VA EHR Sul5Ject: FW: Importance : High 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: Saturday, March 17, 2018 2:23:32 PM To:l(b)(6) I VA-18-0298-I-000707 Page 1346 of 23rb~ of 1380 Cc: Blackburn , Scott R.;l(b)(S) lwindom, John H. Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Dearl(b)(S)II 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(b)(S) @-va.gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott,M.D. l(b)(6) @mgh.harvard.edu> Cc: Blackburn , Scott R. ; ~l (b-)(-6)---------~l Windom, John H. Subject: RE: Scheduling a Call Regard ing 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 l(b)(6) l@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 Dearl(b)(6I 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 6 (b_)(_ l_______________ From: ~' ~ ~-va.gov] VA-18-0298-I-000708 Page 134 7 of 23rbi of 1380 Sent: Friday, March 16, 2018 7:12 PM To: Stan Huff (b)(6) imail.org>; Cooper, Leslie T., M.D.( b)(6) Andrew Scott,M.D. (b)(6) mgh.harvard.edu>; ShresthL... a-, .....-a-su----.-. ,....,..,,. (b.,...., )(6 -:--:)-=- - :...,...... upmc.edu> ; 6 Rasu Shrestha (b)( ) gmail.com> Cc: Blackburn, Scott R. ; Windom , John H. ; l(b)(5 ) l(b)(6) @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) From: ..... l(b_)(_6)______ _, 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' l 'Bruce Moskowitz'; 'Carolyn@Bru ce Cc: Blackburn , Scott R. ; Windom , John H.;j(b)(6) Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan' ; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subje ct: 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 w ith any questions . Thank you, l(b)(6) I From: .,_l (b""' )('""' 6)'- ____ _. 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 , Ras u B': 'Ras u Shrestha' Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6) ] Bruce Moskowitz; 'Carolyn@Bruce VA-18-0298-I-000709 Page 1348 of 23rbi of 1380 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 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 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 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/-comp lianceline . 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-I-000710 Page 1349 of 23r~i of 1380 Document ID: 0.7.1705.1772117 From: Blackburn , Scott R. To: Bruce Moskowitz 6l__ l(b)(6) @ mac .com> ; Marc Sherman ._l (b_)(_ l(b)(6) ] Bee: VA EHR call Subject: Sun Mar 18 2018 12:28:34 EDT Date: Attachments: _. tci2gmail.com> 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 . Thank s again for the help, Scott I 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) VA-18-0298-I-000711 Page 1350 of 23r~~ of 1380 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. 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. ; (b)(6) Windom, John H. Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Dearl(bl(5l II 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-I-000712 Page 1351 of 23r~~ of 1380 From:l(b)(G) @va .gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott,M.D. l(b)(6) @mgh.h...c. a"-rv'""' a-"rd = ·~e..;;;. d= u> _______ Cc: Blackburn , Scott R. ; l(b)(6) 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 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) (b)(6) I_ From: Karson , Andrew Scott ,M.D .~-----~ rmmgh.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 l I Dearl(b)(6* 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 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(b)(G) Sent: Friday, March 16, 20 18 7:12 PM To: Stan Huff b 6 im ii.erg>; Cooper, Leslie T ., M.D. (b)(6) .edu> ; Karson , @mgh.harvard.edu>; Shrestha , Rasu B (b)(6) upmc .edu> ; b 6 Andrew Scott, Rasu Shrestha (b)(G) gmail.com> (b_)(6 _l_~ Cc: Blackburn, Scott R. ; Windom , John H. : l~ l(b)(6) @va.gov> Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High VA-18-0298-I-000713 Page 1352 of 23r~~ of 1380 Good evening , Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening , l(b)(6) I From: j(b)(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'; 'Caro lyn@Bruce Cc: Blackburn , Scott R.; Windom, John H.;l(b)(6) 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 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: ~l (b_)(6_) _____ ~ Sent: Thursday , March 15, 2018 7:27 PM To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)' :l(b)(6)1@facs.org'; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott,M.D.'; 'Shrestha , Rasu B'; 'Rasu Shrestha' Bruce Moskowitz; 'Caro lyn@Bruce Cc: Blackburn , Scott R.; Windom, John H.l(b)(6) Moskowitz.MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Schedu ling a Call Regard ing Feedback on VA EHR I 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 with many of you on diffe rent dates and times next week, but we are going to VA-18-0298-I-000714 Page 1353 of 23r~i of 1380 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-I-000715 Page 1354 of 23r~~ of 1380 Document ID: 0.7.1705.505723 From: Blackburn, Scott R. To: Bruce Moskowitz ~ )(6) ~ mac .com>; Marc Sherman l(b)(6) @gmail.com> _(b)(6) _ Cc: Bee: VA EHR call Subject: Sun Mar 18 2018 12:28:34 EDT Date: 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 I 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 (probab ly joining late) VA-18-0298-I-000716 Page 1355 of 23r~i of 1380 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(b)(6) 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) Cc: Blackburn , Scott R. ; (b)(6) Windom, John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dea rl(b)(6~1am 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-I-000717 Page 1356 of 23r~~ of 1380 From: l(b)(6) @va .gov] Sent: Saturday, March 17, 2018 12: 15 PM To: Karson, Andrew Scott,M.D. l(b)(6) @mgh.harvard.edu> Cc: Blackburn , Scott R. ; .-l (b-)(-6)------------,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 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(b)(6) l@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 Dea rl(b)(6llso 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 From:l(b)(6) l@va.gov] Sent: Friday , March 16 2018 7:12 PM To: Stan Huff (b)(6) imail.org>; Cooper, Leslie T., M.D. (b)(6) Andrew Scott, M.D (b)(6) mgh.harvard .edu>; ShresthaL,...., R """a_s_u..., B =-r.(b:-:)-:--:: (6-:--' ) =---':.., ~ upmc .ed u>; Rasu Shrestha( b)(6) gmail.com> 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 VA-18-0298-I-000718 Page 1357 of 23r~i of 1380 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)(6) 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' l'Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.:l(b)(6) Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan' ; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regard ing 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 , ~ From: ~l (b_)(_s J_____ ~ Sent: Thursday, March 15, 2018 7:27 PM facs.org' ; 'Cooper, Leslie T., M.D.' ; To: Stephanie Ree l; 'Stan Huff ; 'Manis, Jonathan (Jon)';~ 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B'· 'Rasu Shrestha' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;r )(S) Moskowitz .MD'; 'Ash ley 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-I-000719 Page 1358 of 23r~i of 1380 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 US Department of Veterans Affairs Desk: 202-461-6288 (b_)(6_ ) ___ Cell: l._ __. 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-I-000720 Page 1359 of 23r1 i of 1380 Document ID: 0.7.1705.505302 ...._)(_6 )______ l(b ..... l 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. Se l SahJCdav March 17, 2018 2:28 PM To: (b)(6) I VA-18-0298-I-000721 Page 1360 of 23r1~ of 1380 Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Importance: High Maybe pulse Monday/Wednesday nights as we ll (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. ; (b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dea~(b)(6lham 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 6 l(b-. )(..... l --.-----.-..----.---,.---........ ,.......,...,.....,..,....,..l'T"'ll"""----'l @va .gov] From :.... Sent: Saturday, March 1/ , 2018 12: 15 PM To: Karson, Andrew Scott,M.D.l(b)(6) @mgh.harvard.edu> Cc: Blackburn , Scott R. ;,....l (b-)(-6)-----------.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 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-I-000722 Page 1361 of 23r1~ of 1380 From: Karson, Andrew Scott,M.D. l(b)(6) @mgh.harvard.edu] Sent: Frida:. March 16 2018 7:22 PM To: l(b)(6) Subject: [E TERNA[ ] Scheduling a Call Regarding Feedback on VA EHR :J: Dea rl(b)(6llso 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(b)(6) Sent: Friday, March 16, 2018 7:12 PM @imail.org>; Cooper, Leslie T ., M.D .(b)(S) To: Stan Huff l(b)(6) Andrew Scott,M.D .l(b)(6) l@mgh.harvard.edu>; ShresthL... a-, ;:::; R-a-su----;::; B:r:: (b ~)-:-:: (6':"'" ) ..c::.:::....,;.;,,:_,~ upmc .edu> ; Rasu Shrestha l(b)(6) l@gmail.com> Cc: Blackburn , Scott R. ; Windom , John H. ; l(b)(S) l(b)(6) @va.gov> Subject: RE: Scheduling 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_J(_ sJ_____ ___. Sent: Friday, March 16, 20181:06 PM facs .org'; 'Cooper , Leslie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; To: 'Stephanie Reel'; 'Stan Huff' ;~ 'Shrestha, Rasu B'; 'Rasu Shrestha' l 'Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.l(b)(S) 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, VA-18-0298-I-000723 Page 1362 of 23r1~ of 1380 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_)(_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' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R.; Windom, John H.; l(b)(6) 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 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 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 , (b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell j(b)(S) VA-18-0298-I-000724 Page 1363 of 23r1i of 1380 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-I-000725 Page 1364 of 2 72~of 1380 Document ID: 0.7.1705.1772062 From: Blackburn, Scott R. (b)(6) /o=va/ou=exchange To: administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Cc: Bee: Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 14:27:57 EDT Attachments: 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) Cc: Blackburn , Scott R.;(b)(6) Windom, John H. Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dea~(b)(G)l1am 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 Fromj(b)(6) l@va .gov] Sent: Saturday , March 17, 2018 12:15 PM To: Karson, Andrew Scott,M.D l(b)(6) @mgh.harvard.edu> Cc: Blackburn , Scott R. : l,(b-)(-6)----------. Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High @va.gov> ; Good afternoon Dr. Karson, VA-18-0298-I-000726 Page 1365 of 23r1i of 1380 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 J(b)(6 ) l@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 Dea~(b)(6l bo 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 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-I-000727 Page 1366 of 23r1~ of 1380 I Fro~ (b)(6) 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' fBruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6) 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) J From: l(b)(6) Sent: I hursday, March 15, 2 18 7:27 PM To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon)' t ~( 6]@tacs .org' ; 'Cooper , Leslie T., M .D.'; 'Karson, Andrew Scott,M.D.' ; 'Shrestha , Rasu B'; 'Rasu restha' Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6) Bruce Moskowitz; 'Carolyn@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, l(b )(6) l(b)(6) VA-18-0298-I-000728 Page 136 7 of 23r1i of 1380 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-I-000729 Page 1368 of 23r1i of 1380 Document ID: 0.7.1705.505283 From: Blackburn , Scott R. (b)(6) To: Cc: Bee: Subject: FW: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 14:27 :57 EDT Attachments: 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. (b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Dearl~b)(6l1am 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.) Thank s and best, Andy From:l(b)(S) @va .gov] Sent: Saturday , March 17, 2018 12:15 PM @mgh.hr= a~rv~a~rd=.e =d=u~>______ To: Karson, Andrew Scott,M.D. l(b)(6) Cc: Blackburn , Scott R. ; l(b)(6) 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-I-000730 Page 1369 of 23r1i of 1380 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) 6l____ From: Karson , Andrew Scott,M.D. '-Tl (b.... )(..... ~l @mgh.harvard .edu] Sent: Friday, March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR I Dea ~(b)(6~so sorry for the delay getting back to you ; I have been on the road most of yesterday /today and Irst 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 From:l(b)(6) l@va .gov] Sent: Friday , March 16, 2018 7:12 PM To: Stan Huff (b)(6) imail.org>; Cooper, Leslie T ., M.D.i:.... (b..:..: l(:,;..:6) :...._--=..r,;-;-:::::=-'-'-"'-z.., Andrew Scott,M .D. (b)(6) mgh.harvard.edu>; Shrestha , Rasu B (b)(6) upmc.edu> ; Rasu Shrestha l(b)(6) l@gmail.com> Cc: Blackburn , ScottR ; Windom , John H. ; l(b)(6l 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, l(b)(6) VA-18-0298-I-000731 Page 1370 of 23r\~ of 1380 From: ~l (b_)(6_l ____ ~ 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' ·Bruce Moskowitz'; 'Carolyn@Bru ce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6 ) 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 schedu le. Please feel free to call me with any quest ions. Thank you , l(b)(6) From:.... l(b_)(_6l______ ___, Sent: Thur sday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff'; 'Manis, Jonathan (Jon)'l(b)(6l l@facs.org'; 'Cooper, Leslie T. , M.D.' ; 'Karson , Andrew Scott,M.D.'; 'Shrestha , Rasu B': 'Rasu Shrestha' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6 ) 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 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) VA-18-0298-I-000732 Page 1371 of 23r\~ of 1380 Executive Assista nt to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 (b_ )(G_) Cell: 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-I-000733 Page 1372 of 23r\~ of 1380 Document ID: 0.7.1705.1222175 From: Karson Andrew Scott,M.D . (b)(6) mgh.harvard.edu> (b)(6) Cc: Blackburn , Scott R. l~ ; Windom, John H. Bee: Subject: [EXTERNAL] RE: Schedul ing a Call Regard ing Feedback on VA EHR Date: Sat Mar 17 2018 14:23 :32 EDT Attachments: Dea rl~b)(6 l1 am part icipating 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)(6) @va.gov] Sent: Saturday , March 17, 2018 12:15 PM @mgh.hi-"" a"'"" rv""'a=r-= d---= .e=d=u_ >______ To : Karson , Andrew Scott ,M.D. (b)(6) 6 Cc: Blackburn , Scott R. ;l(b)( ) Windom , John H. Subject: RE : Scheduling a Call Regard ing 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 (b-)(_s)____ ~ ~mgh.harvard.edu) VA-18-0298-I-000734 Page 1373 of 23r1i of 1380 Sent: Friday , March 16, 2018 7:22 PM To: l(b)(6) Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR I Dea~(b)(Sllso 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 From:l(b)(S) @va.gov] Sent: Friday, March 16 2018 7:12 PM To: Stan Huff (b)(6) imail.org>; Cooper, Leslie T., M.D. L----~(b)(S) __,,,,«-- --"'--, 6 Andrew Scott,M.D. (b)( ) mgh.harvard.edu>; Shrestha , Rasu B ... (b-'-' )('6) ""''-------" = Rasu Shrestha l(b)(6) @gmail.com> Cc: Blackburn; Scott R. ; Windom , John H. ; l(b)(6) l(b)(6) _ @va.gov> Subject: RE: chedu 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_)(_ 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' 'Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John HJb )(S) Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importan ce: High I Good afternoon, VA-18-0298-I-000735 Page 1374 of 23r\~ of 1380 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 (Jon)'; (b)(6) facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson, Andrew Scott,M.D.'; 'Shrestha , Rasu B': 'Rasu restha' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6) 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)(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 VA-18-0298-I-000736 Page 1375 of 23r1i of 1380 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-I-000737 Page 1376 of 2:H~of 1380 Document ID: 0.7.1705.505278 Karson, Andrew Scott,M.D. From: l(b)(6) @ mgh.harvard.edu> l(b)(6) To: Cc: Blackburn , Scott R. ; .... Bee: Subject: [EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Sat Mar 17 2018 14:23:32 EDT Date: Attachments: I Dea~(b)(6ll1am 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(b)(6) @va .gov] Sent: Saturday, March 17, 2018 12:15 PM To: Karson, Andrew Scott ,M.D.l(b)(6) @mgh.harvard.edu> Cc: Blackburn , Scott R. ; ~l (b-)(-6)---------~ Windom, John H. Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High t@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) VA-18-0298-I-000738 Page 1377 of 23r1i of 1380 From: Karson , Andrew Scott ,M.D .l(b)(6) @mgh .harva rd.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 Dea rl(b)(6 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 From l(b)(S) @v a.gov] Sent: Friday, March 16, 2018 7:12 PM l@mayo .edu> ; Karson, To: Stan Huff (b)(6) imai l.org >; Cooper, Leslie T. , M.D. l(b)(6) Andrew Scott ,M.D . (b)(6) @mgh.harvard.edu>; Shrestha , Rasu B !(b)(6) @upmc .edu> ; Rasu Shrestha (b)(6) gmail.com> Cc: Blackburn, Scott R. ; Windom , John H. ; l(b)(6) l(b)(6) @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) From: ~l (b_)(_6)______ ~ Sent: Friday, March 16, 20181:06 PM To: 'Stephanie Reel'; 'Stan Huff' ;Kb)(G@facs.org'; 'Cooper , Lesl ie T., M.D.'; 'Karson, Andrew Scott ,M.D.' ; · 'Shrestha, Rasu B'; 'Rasu Shrest~ Cc: Blackburn , Scott R. ; Windom, John H.l(b)(S) l·sruce Moskowitz'; 'Carolyn@Bruce Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid'; 'Marc Sherman'; 'IP' Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Importance : High VA-18-0298-I-000739 Page 1378 of 23r1i of 1380 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(b)(6) Sent: Thursday, March 15, 2018 7:27 PM To: Stephanie Reel; 'Stan Huff; 'Manis, Jonathan (Jon)'; l~b)(6 l@facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott ,M.D.' ; 'Shrestha , Rasu B'; 'Rasu Shrestha' Bruce Moskowitz; 'Carolyn@Bruce Cc: Blackburn , Scott R.; Windom , John H.; l(b)(6) 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)(6) VA-18-0298-I-000740 Page 1379 of 23r1i of 1380 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-I-000741 Page 1380 of 2 74~of 1380 Document ID: 0.7.1705.1772005 Blackburn , Scott R. (b)(6) Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 2018 12:17:08 EDT Attachments: Thanks so much! Enjoy your Saturday. I'll be at the ice rink with little kids all afternoon. From:'""l (b"'"" )(""'"6 )_____ ____, Sent: Saturday, March 17, 2018 12:16 PM To: Blackburn, Scott R. Subject: RE: EHR Call Update as of 8PM Okay, emails have been sent. I'll get you an update tonight! Let me know if there is anything else I can do to help :-) From: Blackburn, Scott R. Sent: Saturday, March 17, 201811:47 AM To:l(b)(6) Subject: RE: EHR Call Update as of 8PM Importance : High I Thanks. I apologize for the weekend work . This EHR contract will hopefully be done soon. We have about a 2 week window to close the deal; otherwise it is going to drag on. (b_)(G_ )_____ ~ From: ~l Sent: Saturday, March 17, 2018 11 :06 AM To : Blackburn, Scott R. Subject: RE: EHR Call Update as of 8PM Okay , will do! VA-18-0298-I-000742 Page 1381 of 23r\~ of 1380 Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 10:52:28 AM To j(b)(6) Subject: RE: EHR Call Update as of 8PM I Just looking at this. Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm, 6pm, 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an email that basically says ... ? "Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening is seeming to be the best time. If we made the call later, say 5pm, 6pm, 7pm or 8pm ET .... would you be able to make that work?" If that is what it is looking like, I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce to help push a little bit as well. Thanks I From:l(b)(G) Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday VA-18-0298-I-000743 Page 1382 of 23r\~ of 1380 Moskowitz X X X Perlmutter Sherman Reel X Huff X Rasu Manis VA-18-0298-I-000744 Page 1383 of 2 7l~of 1380 X Ko confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X X Blackburn X X X Trux X VA-18-0298-I-000745 Page 1384 of 2 74~of 1380 X X 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-I-000746 Page 1385 of 23r1i of 1380 Document ID: 0.7.1705.505 101 Blackburn , Scott R. (b)(6) Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 2018 12:17:08 EDT Attachments: Thanks so much! Enjoy your Saturday . I'll be at the ice rink with little kids all afternoon . (b_)(_ 6)_____ ~ From: ~l Sent: Saturday , March 17, 2018 12:16 PM To : Blackburn , Scott R. Subject: RE: EHR Call Update as of 8PM Okay , ema ils have been sent. I'll get you an update tonight! Let me know if there is anything else I can do to help J From: Blackburn, Scott R. Sent: Saturday , March 17, 2018 11:47 AM To :l(b)(6) I Subject: RE: EHR Call Update as of 8PM Importance : High Thanks . I apologize for the weekend work . This EHR contract wi ll hopefully be done soon. We have about a 2 week window to close the deal; otherwise it is going to drag on. I From:l(b)(6) Sent: Saturday , March 17, 20 18 11 :06 AM To : Blackburn, Scott R. Subject: RE: EHR Call Update as of 8PM Okay, wi ll do! VA-18-0298-I-000747 Page 1386 of 23r\~ of 1380 Sent with Good (www.good .com) l(b)(6) From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 10:52:28 AM To: Callaghan , Elizabeth Subject: RE: EHR Call Update as of 8PM Just looking at this. Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm, 6pm , 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an email that basically says ... ? "SorrY,for the extra email but we are having trouble finding a time that works for everyone. Right now, Tues cJ(b)(6) ~ be the best time. If we made the call later , say 5pm, 6pm, 7pm or 8pm ET .... would you be able to make that work?" If that is what it is looking like, I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce to help push a little bit as well. Thanks Frol(b)(6) lh Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, 6)_____ As of ~~(b_)(_ ~ ~sponses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday VA-18-0298-I-000748 Page 1387 of 23r1i of 1380 Moskowitz X X X Perlmutter Sherman Reel X Huff X Rasu Manis VA-18-0298-I-000749 Page 1388 of 2 74~of 1380 X Ko confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X X Blackburn X X X Trux X VA-18-0298-I-000750 Page 1389 of 2 75~of 1380 X X 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~ )(G ~)----~ VA-18-0298-I-000751 Page 1390 of 23r~ of 1380 Document ID: 0.7.1705.1529351 l(b)(6) l To: Blackburn, Scott R. Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 2018 12:16:07 EDT Attachments: Okay , emails have been sent. I'll get you an update tonight! Let me know if there is anything else I can do to help :-) From: Blackburn, Scott R. Sent Satu rd:- March 17, 2018 11:47 AM To :l(b)(6) SubJect: RE: HR Call Update as of 8PM Importance : High I Thank s. I apologize for the weekend work . Thi s EHR contract will hopefully be done soon. We have about a 2 week window to close the deal; otherwise it is going to drag on. From:l(b)(6) I Sent: Saturday , March 17, 2018 11:06 AM To : Blackburn, Scott R. Subject: RE: EHR Call Update as of 8PM Okay , will do! Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Saturday . March 17. 2018 10:52:28 AM To :l(b)(6) Subject: RE: EHR Call Update as of 8PM I VA-18-0298-I-000752 Page 1391 of 23r~ of 1380 Just looking at this . Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm, 6pm, 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an email that basically says ... ? "Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening is seeming to be the best time. If we made the ca ll later , say 5pm, 6pm, 7pm or 8pm ET .... would you be able to make that work?" If that is what it is looking like , I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce to help push a little bit as well. Thanks From: l(b)(6) I Sent: Friday, March 16, 2018 8:01 PM To : Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks, the "x" indicates they are available. Sunday Monday Tuesday Moskowitz X X X Perlmutter VA-18-0298-I-000753 Page 1392 of 23r~ of 1380 Shannan Reel Hu? Rasu Manm K0 Page13930f2?g? of 1380 confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X X Blackburn X X X Trux X X X VA-18-0298-I-000755 Page 1394 of 2 75~of 1380 l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce lij(b)(G) VA-18-0298-I-000756 Page 1395 of 23r~ of 1380 Document ID: 0.7.1705.1222361 From: l(b)(G) fto=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> To: Karson , Andrew Scott ,M.D. l(b)(6) @mgh .harvard.edu> Cc: Blackburn , Scott R. J~ (b_)(_G )..,...,....,.,__,,.-----,-....,......... ; Windom, John H. Bee: Subject: RE: Scheduling a Call Regarding Feedback on VA EHR Date: Sat Mar 17 2018 12:15 :27 EDT Attachments: 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 ava ilable? So far Tuesday seems to work best for everyone . Thank s again! ~ From: Karson , Andrew Scott ,M.D J{b)(G) Sent: Friday, March 16, 2018 7:22 PM Tok~~) @mgh.harvard.edu) I Subject: [EXTERNAL] RE: Schedul ing a Call Regarding Feedback on VA EHR Dea rj(b)(6* o 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(b)(6) Sent: Friday, March 16, 2018 7:12 PM ~----~ 6)__ To: Stan Hu (b)(6) ii.erg>; Cooper, Leslie T., M.D. i.:.. (b..:...; )(.....: -f'.':"7~.......,........,_..,., .edu> ; Karson , 6 Andrew Scott,M.D . (b)( ) mgh.harvard.edu>; Shrestha , Rasu B (b)(6) upmc .edu> ; VA-18-0298-I-000757 Page 1396 of 23rm, of 1380 Rasu Shrestha l(b)(6) ~gmail.com> Cc: Blackburn, Scott R. ; Windom , John H. ; l(b)(G) @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, ~ I From:l(b)(G) Sent: Friday , March 16, 20181:06 PM To: 'Stephanie Reel' ; 'Stan Huff'~ facs .org' ; 'Cooper , Leslie T. , M.D.'; 'Karson , Andrew Scott ,M.D.' ; b 'Shrestha, Rasu B'; 'Rasu Shrestha' 6 Cc: Blackburn , Scott R. ; Windom, John HJ )( ) 'Bruce Moskowitz'; 'Carolyn@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 w ith any questions . Thank you, l(b)(6) From: .... l(b_)(_ 6)_____ ___, 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' Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6 ) !Bruce Moskowitz; 'Carolyn@Bruce Moskowitz.MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Scheduling a Call Regarding Feedback on VA EHR VA-18-0298-I-000758 Page 1397 of 23rYs of 1380 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 (b_)(G _) ___ Cell: l~ ~ 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-I-000759 Page 1398 of 23r~ of 1380 Document ID: 0 7 1705 505092 ~l To: Karson , ndrew Scott,M.D . l(b)(G) .@mgh.harvard.edu> Cc: Blackburn, Scott R. ; .... Bee: RE: Scheduling a Ca ll Regarding Feedback on VA EHR Subject: 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 avai lable? So far Tuesday seems to work best for everyone . Thanks again! l(b)(6) From: Karson, Andrew Scott,M.D J b)(G) @mgh.harvard.edu ] Se r Ecidav March 16 2018 7:22 PM To: ~b)(6) Subject: [EXTERNAL] RE: Sc heduling a Call Regarding Feedback on VA EHR I 5 Dea rlcb>< > 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 on ly time among those th ree that I can do is the Tuesday time. (I will be part of an out of town family eve nt on Sunday and in the air on Monday.) Many thanks and best, Andy 6 From:.... l(b-)(_ )_______________ _. ~ va.gov] VA-18-0298-I-000760 Page 1399 of 23r1i of 1380 Sent: Friday , March 16, 2018 7:12 PM To: Stan Huff b 6 imail.org>; Cooper, Leslie T., M.D.L... (b_)(_6)_____ =.:..:.=L.., Andrew Scott,M.D (b)(6) mgh.harvard.edu>; Shrestha , Rasu B (b)(6) upmc.edu> ; Rasu Shrestha (b)(6) gmail.com> Cc· Blackb1,ro Scott R ; Windom , John H. ; l(b)(6) l(b)(6) @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) I From:l(b)(6) Sent: Friday , March 16, 2018 1:06 PM .org'; 'Cooper , Leslie T ., M.D.'; 'Karson, Andrew Scott,M.D.'; To : 'Stephanie Reel' ; 'Stan Huff'~facs 'Shrestha, Rasu B'; 'Rasu Shres~ 'Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom, John H.j(b)(G) Moskowitz .MD'; 'Ashley Johnson'; 'Mary Riordan'; 'Mehwesh Khalid' ; 'Marc Sherman'; 'IP' Subject: RE: Schedu ling 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 schedu le. Please feel free to call me with any questions . Thank you, l(b)(6) From:~l (b_)(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(b)(6) Bruce Moskowitz; 'Carolyn@Bruce I VA-18-0298-I-000761 Page 1400 of 23r1~ of 1380 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, 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_)(S _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-I-000762 Page 1401 of 23r1~ of 1380 Document ID: 0.7.1705.504686 From: Blackburn, Scott R. To: (b)(6) Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 201811:47:06 EDT Attachments: Thanks. I apologize for the weekend work. This EHR contract will hopefully be done soon. We have about a 2 week window to close the deal; otherwise it is going to drag on. I From:l(b)(6) Sent: Saturday , March 17, 2018 11:06 AM To: Blackburn, Scott R. Subject: RE: EHR Call Update as of 8PM Okay , will do! Sent with Good (www.good.com) From: Blackburn, Scott R. Sent: Saturday, March 17, 2018 10:52:28 AM To: l(b)(6) Subject: RE: EHR Call Update as of 8PM I Just looking at this. Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm, 6pm, 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an email that basically says ... ? "Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening is seeming to be the best time. If we made the call later, say 5pm, 6pm, 7pm or 8pm ET .... would you be able to make that work?" If that is what it is looking like, I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce VA-18-0298-I-000763 Page 1402 of 23r1~ of 1380 to help push a little bit as well. Thanks (b_)(_6)_____ ~ From: ~l Sent: Friday , March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday Moskowitz X X X Perlmutter Sherman VA-18-0298-I-000764 Page 1403 of 23r1i of 1380 Reel X Huff X Rasu Manis X Ko confi rmed for Monday at 2PM contract overview Cooper VA-18-0298-I-000765 Page 1404 of 27e~ of 1380 Karson X Windom X X X Blackburn X X X Trux X X X l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell:1(b_J(_SJ___ ~ VA-18-0298-I-000766 Page 1405 of 23r1i of 1380 Document ID: 0.7.1705.1529057 l(b)(6) l To: Blackburn, Scott R. Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 2018 11 :05:37 EDT Attachments: Okay , will do! Sent with Good (www.good .com) From: Blackburn, Scott R. Sent: Satu rday, March 17, 2018 10:52:28 AM To: l(b)(6) Subject: RE: EHR Call Update as of 8PM I Just looking at this. Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm , 6pm , 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an ema il that basically says ... ? "Sorry for the extra ema il but we are having trouble finding a time that works for everyone. Right now, Tuesday even ing is seem ing to be the best time. If we made the ca ll later, say 5pm, 6pm, 7pm or 8pm ET ....would you be able to make that work?" If that is what it is loo king like , I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce to help push a little bit as well. Thanks I From ~~~ ) Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. VA-18-0298-I-000767 Page 1407 of 23r1~ of 1380 Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday Moskowitz X X X Perlmutter Sherman Reel X VA-18-0298-I-000768 Page 1408 of 2 78~of 1380 Huff X Rasu Manis X Ko confi rmed for Monday at 2PM contract overview Cooper Karson X VA-18-0298-I-000769 Page 1409 of 27e~ of 1380 Windom X X X Blackburn X X X Trux X X X l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 (b_)(6_) --~ Cell: l~ VA-18-0298-I-000770 Page 1410 of 23i% of 1380 Document ID: 0.7.1705.504678 From: Blackburn, Scott R. To: (b)(6) Cc: Bee: Subject: RE: EHR Call Update as of 8PM Date: Sat Mar 17 2018 10:52:28 EDT Attachments: Just looking at this . Perhaps we try to go for a little later Tuesday . Perhaps we ask about 5pm, 6pm, 7pm and even 8pm on Tuesday (since a few people are in Central/Mountain time zones) Do you mind sending them each individually an email that basically says ... ? "Sorry for the extra email but we are having trouble finding a time that works for everyone. Right now, Tuesday evening is seeming to be the best time. If we made the call later , say 5pm, 6pm, 7pm or 8pm ET .... would you be able to make that work?" If that is what it is looking like, I will gladly push my dinner w/ Ryan/Blake back to April. I can get Bruce to help push a little bit as well. Thanks I From:l(b)(G) Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks , the "x" indicates they are available . Sunday VA-18-0298-I-000771 Page 1411 of 23r1A of 1380 Monday Tuesday Moskowitz X X X Perlmutter Sherman Reel X Huff X Rasu VA-18-0298-I-000772 Page 1412 of 2 :n~ of 1380 Manis X Ko confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X X Blackburn X X X VA-18-0298-I-000773 Page 1413 of 2:n~of 1380 Trux X X X 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-I-000774 Page 1414 of 23i% of 1380 Document ID: 0.7.1705.504669 From: Bruce Moskowitz l(b)(6) @mac.com> To: Blackburn, Scott R. Cc: Bee: Subject: [EXTERNAL] Re: EHR Call Update as of 8PM Date: Sat Mar 17 2018 08:40:46 EDT Attachments: Will assist if needed Sent from my iPad Bruce Moskowitz M.D. On Mar 16, 2018, at 9:44 PM, Blackburn, Scott R. wrote : Bruce - I just wanted to give you a heads up. We might need your help to politely nudge a few folks . I'll send each a personal note in the morning to check in and make sure they have everything they (and understand the sense of urgency). If I don't have any luck, I'll let you know. I agree with your quicksand analogy. Politically we expect Congress to pass a budget (omnibus) on March 23. Gerner has strong incentive to sign March 31 or earlier (end of their financial quarter) . So as long as don't find any major showstoppers, I believe we have a nice 2 week window to close this (and then get the hard work started). Thanks again for all your support. At McKinsey we used to use the term "demanding partner". You've been a great demanding partner to make sure we get this right. Scott I From:l(b)(6) Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, VA-18-0298-I-000775 Page 1415 of 23i% of 1380 As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday Moskowitz X X X Perlmutter Sherman Reel X Huff X VA-18-0298-I-000776 Page 1416 of 2:n~of 1380 Rasu Manis X Ko confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X VA-18-0298-I-000777 Page 1417 of 2ff~of 1380 X Blackburn X X X Trux X X X l(b)(6) Executive Ass istant to the Assistant Secretary Office of Info rmation and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell:l._ (b-)(6_) ___ _. VA-18-0298-I-000778 Page 14 18 of 23r1/sof 1380 Document ID: 0.7.1705.504665 From: Blackburn, Scott R. Cc: Bee: Subject: FW: EHR Call Update as of 8PM Date: Fri Mar 16 2018 21:44:15 EDT Attachments: 1> Bruce - I just wanted to give you a heads up. We might need your help to politely nudge a few folks . I'll send each a personal note in the morning to check in and make sure they have everything they (and understand the sense of urgency). If I don't have any luck, I'll let you know. I agree with your quicksand analogy. Politically we expect Congress to pass a budget (omnibus) on March 23. Gerner has strong incentive to sign March 31 or earlier ( end of their financial quarter) . So as long as don 't find any major showstoppers , I believe we have a nice 2 week window to close this (and then get the hard work started) . Thanks again for all your support . At McKinsey we used to use the term "demanding partner ". You've been a great demanding partner to make sure we get this right. Scott I From:l(b)(6) Sent: Friday, March 16, 2018 8:01 PM To: Blackburn, Scott R. Subject: EHR Call Update as of 8PM Good evening Mr. Blackburn, As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday VA-18-0298-I-000779 Page 1419 of 23i% of 1380 Monday Tuesday Moskowitz X X X Perlmutter Sherman Reel X Huff X Rasu VA-18-0298-I-000780 Page 1420 of 2 :n~ of 1380 Manis X Ko confirmed for Monday at 2PM contract overview Cooper Karson X Windom X X X Blackburn X X X VA-18-0298-I-000781 Page 1421 of 2 18~of 1380 Trux X X X 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) VA-18-0298-I-000782 Page 1422 of 23r1~ of 1380 Document ID: 0.7.1705.504583 From: I(b_)(_6)_____ .... ____.I Blackburn, Scott R. Cc: Bee: EHR Call Update as of 8PM Subject: Fri Mar 16 2018 20:00:47 EDT Date: Attachments: Good evening Mr. Blackburn , As of 8PM I have received responses from a few more folks , the "x" indicates they are available. Sunday Monday Tuesday Moskowitz X X X Perlmutter Sherman VA-18-0298-I-000783 Page 1423 of 23r1~ of 1380 Reel X Huff X Rasu Manis X Ko confirmed for Monday at 2PM contract overview Cooper VA-18-0298-I-000784 Page 1424 of 2 18~of 1380 Karson X Windom X X X Blackburn X X X Trux X X X l(b)(6) Executive Ass istant to the Assistant Secretary Office of Info rmation and Technology US Depa rtment of Veterans Affa irs Desk: 202-461-6288 (b_)(6_) ___ Cell : l._ __. VA-18-0298-I-000785 Page 1425 of 23r1~ of 1380 Document ID: 0.7.1705.1221489 From: Stan Huff To: l(b)(6) l; Cooper, Leslie T., M.D.(b)(6) mayo .edu>; Karson , Andrew Scott,M.D. ; Shrestha, R ,_a_s_u_B__ _, @upmc .edu>; Rasu Shrestha l(b)(6) @gmail.com> l(b)(6) Blackburn , Scott R. ; Windom, John H. ;1(b)(6) r 1o=va/ou=visn 03/cn=recipients/cn=vhaeastruexm> l(b)(6) Bee: Subject: (EXTERNAL] RE: Scheduling a Call Regarding Feedback on VA EHR Date: Fri Mar 16 2018 19:18:29 EDT Attachments: l(b)(6) The best date for me is Monday 3/19 at 4PM EST. Thanks , Stan From:l(b)(6) @va .gov] Sent: Friday, March 16, 2018 5:12 PM To : Stan Huff (b)(6) imail.org>; Cooper, Leslie T. , M.D. (b)(6) Andrew Scott,M.D. (b)(6) mgh .harvard.edu >; ShresthLa-, - a-su--f'. (::--:b )~(6:-:-)......._ _..., _ upmc .edu>; Rasu Shrestha (b)(6) gmail.com> Cc: Blackburn, Scott R. ; Windom, John H. :l(b)(6) l(b)(6) @va.gov> Subject: RE: Scheduling 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-I-000786 Page 1427 of 23r1i of 1380 l ______ (b)(6) _, From: .__ 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' Cc: Blackburn , Scott R. ; Windom, John H.;l(b)(6) 'Bruce Moskowitz'; 'Carolyn@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(_ 6J_____ __, Sent: Thursday, March 15, 2018 7:27 PM To : Stephanie Reel; 'Stan Huff ; 'Manis, Jonathan (Jon ~(b)(6) l@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(b)(6) Bruce Moskowitz; 'Carolyn@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-I-000787 Page 1428 of 23r1~ of 1380 Executive Ass istant to the Assistant Secretary Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Cell:l(b)(G) VA-18-0298-I-000788 Page 1429 of 23r1i of 1380 q Document ID: 7 1705 1221485 [(b)(G) To: @imail.o rg>; Stan Huff!(b)(6) Cooper , Leslie T ., M.D. l(b)(6) @mayo .edu>; Karson, Andrew Scott,M.0. l(b)(6) @ mgh.harvard .edu> ; Shrestha , Rasu B !(b)(6) @upmc.edu> ; Rasu Shrestha l(b)(6) @gmail.com> Cc: Blackburn , Scott R. ; Windom, John H. I(b)(G) (b)(6) /o=va/ou=visn 03/cn=recipients/cn =vhaeastrue~x- m _> _~ Bee: RE: Scheduling a Call Regarding Feedback on VA EHR Subject: Fri Mar 16 201819:11:33 EDT Date: Attachments: I Good evening, Another friendly reminder to please let me know which dates works best for your schedule. Have a great evening, ~ 6)_____ From:..... !(b_)(_ __, 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' l'Bruce Moskowitz'; 'Carolyn@Bruce Cc: Blackburn , Scott R. ; Windom , John HJb )(G) 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 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. VA-18-0298-I-000789 Page 1430 of 23r1i of 1380 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 (Jon) j(b)(6) l@facs.org' ; 'Cooper, Leslie T., M.D.' ; 'Karson , Andrew Scott ,M.D.'; 'Shrestha, Rasu B'; 'Rasu Shrestha' Bruce Moskowitz; 'Caro lyn@Bruce Cc: Blackburn, Scott R.; Windom, John H.:!ib)(6) 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)(6) VA-18-0298-I-000790 Page 1431 of 23r1i of 1380 Document ID: 0.7.1705.1527788 -l(b~)(~6)_____ ~I 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 J(b)(6)1 From: Blackburn, Scott R. Sent: Frida , March 16, 2018 11 :57 AM To: (b)(6) Sul:5Ject: atus Update Importanc e: High Yes , please . I want to be able to give Bruce an update by end of the day. (b_)(_6)~ ____ ___. From: ~l Sent: Friday, March 16, 20 1810:36AM To: Blackburn , Scott R. Subject: EHR Call Status Update Good morning Mr. Blackburn, I have only received responses from Dr. Moskowitz and Mr. Manis . Should I sent out a follow up email? X = available Thanks j(b)(G) VA-18-0298-I-000791 Page 1432 of 23r1~ of 1380 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_J(G _) ---~ VA-18-0298-I-000792 Page 1433 of 23r1~ of 1380 Document ID: 0.7.1705 .1527788-000001 Owner : l(b)( 6 ) l Filename: image001 .png Last Modified: Fri Mar 16 12:06:37 CDT 2018 VA-18-0298-I-000793 Page 1434 of 23r1~ of 1380 image001.p g fe!>BMl~lt Moskowitz X er : 5!'Jld>,1'~ ment X 1fQ.f eH day X Perlmutter Sherman Reel Huff Rasu Manis X Ko Cooper Karson VA-18-0298-I-000794 Windom X Blackburn l(b)(6) X I X X X X X ..,age j 435 o 2 )1~'>f-i f 1-:\.RI Document ID: 0.7.1705.1221459 From: ....~)(_6 l(b To: Ste~hanje Re~I l(b)(6) @ihu.edu>; Stan Huff ]b )(S) l9iima il.or (b)(6) facs.org ~ facs.org>; Cooper , Leslie T ., M.D (b)(6) mayo.edu> ; Karson , Andrew Scott,M.D. (b)(6) mg . arvard.edu>; Shrestha, Rasu B l@gmail.com> j(b)(6) l@upmc.edu>; Rasu Shrestha l(b)(6) Blackburn , Scott R. ; Windom, John H. ; (b)(S) (b)(6) ;Carolyn@Bruce @gmai hley Johnson Moskowitz .MD l(b)(6) (b)(6) ·hmi.edu>; Mary Riorda (b)(6) @jhu.edu>; Mehwesh K · (b)(6) facs .org>; Marc Sherman (b)(6) gmail.com>; I (bl( 5>@frenchange 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 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 , ~ 6)~----~ From: ~j (b_)(_ 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(b)(6) Bruce Moskowitz; 'Carolyn@Bruce Moskowitz.MD'; 'Ashley Johnson'; Mary Riordan ; 'Mehwesh Khalid'; Marc Sherman; IP Subject: Schedu ling a Call Regarding Feedback on VA EHR I Good evening , VA-18-0298-I-000795 Page 1436 of 23r1~ of 1380 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)(G) VA-18-0298-I-000796 Page 1437 of 23r1i of 1380 Document ID: 0.7.1705.1770593 From: Blackburn , Scott R. (b)( 6 ) /o=va/ou=exchange To: administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Cc: Bee: RE: EHR Call Status Update Subject: Fri Mar 16 201811:56:50 EDT Date: image001 .png Attachments: Yes , please . I want to be able to give Bruce an update by end of the day. From: .... l(b_)(_ G)______ __, Sent: Friday , March 16, 2018 10:36 AM To: Blackburn, Scott R. Subject: EHR Call Status Update Good morning Mr. Blackburn, I have only received responses from Dr. Moskowit z and Mr. Manis . Should I sent out a follow up email? X = available Thanks, l(b)(G) I l(b)(6) Executive Assistant to the Assistant Secretary Office of Information and Technology VA-18-0298-I-000797 Page 1438 of 23r1~ of 1380 US Department of Veterans Affairs Desk: 202 -461-6288 Cell :l(b)(G) VA-18-0298-I-000798 Page 1439 of 23r1i of 1380 Document ID: 0.7.1705.1770593-000001 Owner : Blackburn , Scott R. Filename: image001 .png Last Modified: Fri Mar 16 10:56:50 CDT 2018 VA-18-0298-I-000799 Page 1440 of 2 79~of 1380 image001.p g fe!>BMl~lt Moskowitz X er : 51-.(1 d>,1'~ me nt X 1fQ.f eH day X Perlmutter Sherman Reel Huff Rasu Manis X Ko Cooper Karson VA-18-0298-I-000800 Windom X Blackburn l(b )(6) X I X X X X X ..,age j 44 1 o 2 ~}It1 ~ f 1-:(.RI Document ID: 0.7.1705.504327 From: Blackburn, Scott R. l(b)(6) I To: 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. From lb )(6) ~ Sent:nday , March 16, 201 10:36 AM To : Blackburn, Scott R. Subject: EHR Call Status Update Good morning Mr. Blackburn , I have only received responses from Dr. Moskowitz and Mr. Manis . Should I sent out a follow up email? X = available Thanks, l(b)(6) I l(b)(6) Executive Assistant to the Assistant Secretary VA-18-0298-I-000801 Page 1442 of 2ib~ of 1380 Office of Information and Technology US Department of Veterans Affairs Desk: 202-461-6288 Ce11 :l(b)(6) VA-18-0298-I-000802 Page 1443 of 2ib~of 1380 Document ID: 0.7.1705.504327-000001 Owner : Blackburn , Scott R. Filename: image001 .png Last Modified: Fri Mar 16 10:56:50 CDT 2018 VA-18-0298-I-000803 Page 1444 of 2~ 0~of 1380 image001.p g fe!>BMl~lt Moskowitz X er : 5M d>r1'~ ment X 1fQ.f eH day X Perlmutter Sherman Reel Huff Rasu Manis X Ko Cooper Karson VA-18-0298-I-000804 Windom X Blackburn l(b)(6) X I X X X X X ..,age j 445 o 2 ~}Il~f 1-:(.RI Document ID: 0.7.1705.504201 l(b)(6) To: Blackburn, Scott R. Cc: Bee: Subject: EHR Call Status Update Date: Fri Mar 16 2018 10:35 :59 EDT Attachments: image001 .png I Good morning Mr. Blackburn, I have only received responses from Dr. Moskowitz and Mr. Manis . Should I sent out a follow up email? X = available Thanks, l(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(b)(6) VA-18-0298-I-000805 Page 1446 of 2ib~of 1380 Document ID: 0.7.1705.504201-000001 Owner : l(b)(6) l Filename: image001 .png Last Modified: Fri Mar 16 09:35:59 CDT 2018 VA-18-0298-I-000806 Page 1447 of 2ibiof 1380 image001.p g fe!>BMl~lt Moskowitz X er : 5M d>r1'~ ment X 1fQ.f eH day X Perlmutter Sherman Reel Huff Rasu Manis X Ko Cooper Karson VA-18-0298-I-000807 Windom X Blackburn l(b )(6) X I X X X X X ..,age j 448 o 2 1\h~ '>f-i f 1-:\.RI Document ID: 0.7.1705.821501 From: Windom, John H. To: Blackburn, Scott R. ; DJS ; Bowman , Thomas Cc: Bee: Subject: RE: [EXTERNAL] Re: Scheduling a Call Regard ing 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 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 MobileJ~(b_)(S _)___ ~ 6 Executive Assistant: Ms. ~l (b_)(_ )__ ._l (b_)(s_)_ ~~ Appointments and Scheduling _. @va .gov Office: 202-382-3792 VA-18-0298-I-000808 Page 1449 of 2ibiof 1380 From: Blackburn, Scott R. Sent: Thursday, March 15, 2018 8:45 PM To: DJS ; Windom , John H.; Bowman, Thomas Subject: FW: [EXTERNAL] Re: Schedu ling 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 he lp push these folks for us. Sent with Good (www.good .com) From: Bruce Moskowitz Sent: Thursda y, March 15, 2018 7:27: 17 PM To: l(b)(6) Cc: Stephanie Ree l; Stan Huff; Manis, Jonathan (Jon ~(b)(6)l@facs.org ; Cooper , Lesl ie T., M.D.; Karson l Andrew Scott,M.D .; Shrestha, Rasu B; Rasu Shrestha; Blackburn , Scott R. ; Windom , John H.; l(b)(6) l(b)(6) ICarolyn@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 All work for me Sent from my iPad Bruce Moskowitz M.D . On Mar 15, 2018 , at 7:26 PM, .... l(b_)(_si_____________ ___. ~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 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, ~ VA-18-0298-I-000809 Page 1450 of 2ibiof 1380 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,__ (b_)(6_) ___ __. VA-18-0298-I-000810 Page 1451 of 2i~i of 1380 Document ID: 0.7.1705.503807 From: Blackburn, Scott R. 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: l(b)(6) 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.;l(b)(6) !{bl(6l r;arolyn@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. (b"'"" )(--" 6)____________ On Mar 15, 2018 , at 7:26 PM,'""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 VA-18-0298-I-000811 Page 1452 of 2i~~ of 1380 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 (b_)(6_) __ Cell : l._ ____. VA-18-0298-I-000812 Page 1453 of 2i~~ of 1380 Document ID: 0.7.1705.821407 From: Blackburn, Scott R. 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 j(b)(6) 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.; l(b)(6) l(b)(6) Carolyn@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 I All work for me Sent from my iPad Bruce Moskowitz M.D. 6l____________ On Mar 15, 2018 , at 7:26 PM, .... l(b_)(_ __.@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 schedu le 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-I-000813 Page 1454 of 2i~~ of 1380 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) VA-18-0298-I-000814 Page 1455 of 2i~i of 1380 Document ID: 0.7.1705.1220029 From: Bruce Moskowitz (b)(6) Stephanie Reel !(b)(6) @jhu.edu>; Stan Cc: Huff (b)(6) imail.org>; Manis, Jonathan (Jon) facs.org ~ facs.org> ; (b)(6) sutterhealth.or b 6 Cooper, Leslie T., M.D. (b)(6) mayo.edu> ; Karson, Andrew Scott ,M.D. (b)(6) mgh .harvard .edu>; Shrestha , Rasu B l(b)(6) @upmc.edu> ; Rasu Shrestha l(b)(6) ~gmail.com>; Blackburn , Scott R. ; Windom, John H. ; (b)(S) _ ; Ashley · ·.edu> ; Mary Riordan (b)(6) @jhu .edu>; Johnson b 6 Mehwesh Khalid (b)(6) facs .org> ; Marc Sherman l(b)(6) ~gma1 .com>; IP~fr enchange 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. 6 On Mar 15, 2018, at 7:26 PM, I~(b_)(_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 correspond ing 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, ~ VA-18-0298-I-000815 Page 1456 of 2i~~ of 1380 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 _)___ ~ VA-18-0298-I-000816 Page 1457 of 2i~i of 1380 Document ID: 0.7.1705.503798 From: BruceMoskowitz l(b)(6) @mac.com> 1'b)(6) ] To: ; Stan Cc: Huff (b)(6) imail.org>; Manis, Jonathan Jon) (b)(6) sutterhealth.or facs.o r (b)(6) facs.org> ; b 6 Cooper, Leslie T., M.D. b 6 mayo .edu>; Karson , Andrew Scott ,M.D (b)(6) mgh.harvard.edu>; Shrestha, Rasu B i(b)(6) @upmc .edu>; Rasu Shrestha l(b)(6) @gmail.com> ; Blackburn , Scott R. ; Windom, John H. ;( b)(6) /o=exchange labs/ou=exchange administrat ive group (fydibohf23spdlt)/cn=recipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2 b 6 ; Ca rolyn@Bruce Moskowitz .MD !(b -)(-6)---. @jhmi.edu >; (b)(6) gmail.com>; Ashley Johnson ..... Ma Riordan (b)(6) jhu .edu>; Mehwesh Khalid (b)(6) facs.org >; Marc Sherman l(b)(6) @gmail.com >; IP (b)(6) frenchange l59.com> Bee: Subject: [EXTERNAL] Re: Schedu ling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 201819:27:17 EDT Attachments: All work for me Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 20 18, at 7:26 PM,-l(b_)(_6l______________ 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 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-I-000817 Page 1458 of 2i~~ of 1380 (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)(6) VA-18-0298-I-000818 Page 1459 of 2i~i of 1380 Document ID: 0.7.1705.1220026 !(b)(6) l Steghanie Reel l(b)(6) t@jhu.edu>; Stan To: Huff l(b)(6) @ima il.org>; Manis, Jonathan (Jon) !{b)(6) @sutterhealth.or b 6 facs.org ~ facs.org> ; Cooper, Leslie T., M.D (b)(6) mayo.edu> ; Karson, Andrew Scott,M.D (b)(6) mgh .harvard .edu> ; Shrestha , Rasu B j(b)(6) l@upmc.edu> ; Rasu Shrestha l(b)(6) @gmail.com > Cc: Blackburn , Scott R. ; Windom, John H. ; l(b)(6) (b)(6) /o=va/ou=visn 03/cn=recipients/cn=vhaea* b)(G) Bruce Moskowitz l(b)(6) @mac.com>;Carolyn@Bruce l@gmail.com>; Ashley John son Moskowitz MDl(b)(6) 6 (b)( ) 'hmi.edu>; Mary Riordan (b)(6) jhu.edu>; Mehwesh Khalid (b)(6) facs.org>; Marc Sherman b 6 @gmail.com>; l~ frenchangel59.com> Bee: Subj ect: Scheduling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 19:26:32 EDT Attachments: t 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 w ith 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 VA-18-0298-I-000819 Pa ge 1460 of 2i~i of 1380 Celt: (MUS) Page 1461 of 299121;) of 1380 Document ID: 0.7.1705.503799 ~ ~I Ste hanie Reel l(b)(6) @jhu.edu>; Stan To: (b)(6) imail.org> ; Manis, Jonathan (Jon) L.......,.. __ ___,_.. sutterhealth .org (b)(6) @facs.or ~ facs.org> ; Cooper, Leslie T., M.D (b)(6) mayo .edu> ; Karson, Andrew Scott ,M.D (b)(6) mgh .harvard .edu> ; Shrestha , Rasu B l(b)(6) l@upmc .edu> ; Rasu Shresth ~(b)(6) @gmail.com> Cc: Blackburn , Scott R. ; Windom, John H. ; (b)(6) ; Carolyn Bruce Moskowitz,MD (b)(6) mail.com> ; Ashley Johnso (b)(6) jhmi.edu> ; Mary Riordan (b)(6) j hu.edu >; Mehwesh Khalid (b)(6) facs .org>; Marc Sherm an 6]@frenchangel59 .com > l(b)(6) @gmail.com>; IPl(bH Bee: Subject: Scheduling a Call Regarding Feedback on VA EHR Date: Thu Mar 15 2018 19:26 :32 EDT Atta chments: 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 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 VA-18-0298-I-000821 Page 1462 of 2i1~ of 1380 Desk: 202-461-6288 Celt: Page 1463 of 29915 of 1380 Document ID: 0.7.1705.1525910 From: l(b)(6) l To: Blackburn, Scott R. Cc: Bee: RE: [EXTERNAL] Re: EHR VA Call Subject: Thu Mar 15 2018 14:24:44 EDT Date: Attachments: Okay , I w ill start over and get Mr. Marc and Dr. Bruce 's ava ilability first. From: Blackburn, Scott R. Sent: Thursday , March 15, 2018 2:21 PM To :l(b)(6) Subject: FW: [EXTERNAL] Re: EHR VA Call Importanc e: High I 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.; ~l (b_)(6 _)___ Cc:l(b)(6) i@gmail.com; IP; O'Rourke , Peter M. Subject: [EXTERNAL] Re: EHR VA Call ~ 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-I-000823 Page 1464 of 2i1~of 1380 Page 1455 of BEE of 1380 Document ID: 0.7.1705.1769743 From: Blackburn , Scott R. To: l(b)(6) l 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: Thur sday, March 15, 2018 1:27:32 PM To: Windom, John H.; Blackburn , Scott R. ; l..... (b-)(6 _)___ Cc:l(b)(6) @gmail.com; IP; O'Rourke, Peter M. Subject: [EXTERNAL] Re: EHR VA Call __, 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-I-000825 Page 1466 of 2i1~of 1380 Document ID: 0.7.1705.503504 From: Blackburn, Scott R. To: (b)(6) ~------~ 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, 20181:27:32 PM To: Windom , John H.; Blackburn , Scott R.;!,(b-)(-6)-----. Cc:l(b)(6) @gmail.com; IP; O'Rourke , Peter M. Subject: [EXTERNAL] Re: EHR VA Call 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-I-000826 Page 146 7 of 2i1iof 1380 Document ID: 0.7.1705.983013 From: Bruce Moskowitz @mac.com> Windom, John H. ; Blackburn , Scott R. ; ._l !(b)(6) @gmail.com l(b)(6) @gmail.com>; l~frenchangel59.com>; O'Rourke, Peter M. l(b)(6) To: Cc: Bee: Subject: Date: Attachments: [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-I-000827 Page 1468 of 2i1~of 1380 Document ID: 0.7.1705.503481 From: Bwce Moskowitz l(b)(G) @mac.com> To: Windom, John H. ; Blackburn, Scott R. ;~l ; l~frenchangel59. com>; O'Rourke, Peter M. Bee: [EXTERNAL] Re: EHR VA Call Subject: Thu Mar 15 2018 13:27 :32 EDT Date: Attachments: 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 cons iderations 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, VAC IO Executive Schedule wrote : VA-18-0298-I-000828 Page 1469 of 2i1iof 1380 Document ID: 0.7.1705.1218888 From: VAC IO Executive Schedule To: Windom, John H. ; Blackburn , Scott R. -=l (b =)(;-6') ___ _. ; Bruce Moskowitz (b)(6) mac .com> Cc: Bee: EHR VA Call Subject: Thu Mar 15 2018 12:28:02 EDT Date: Attachments: VA-18-0298-I-000829 Page 1470 of 2i1iof 1380 Document ID: 0.7.1705.1769680 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; (b)( ,__ .......... __,.----; Windom, John H. ; Eugmail.com>; Marc Carolyn@Bruce Moskowitz,MD l{b)(6l Sherman l(b)(6) tcygmail.com>; Bruce Moskow itz l(b)(6) !@mac.com> Cc: Bee: VA EHR Call Subject: Thu Mar 15 201811 :23 :07 EDT Date: Attachments: StartTime: Mon Mar 19 11:00:00 Central Daylight Time 2018 EndTime : Mon Mar 19 11:45:00 Central Daylight Time 2018 Location :l(b)(6) lnvitees: !{b)(6) !Blackburn, Scott R.; Windom , John H.; Carolyn@Bruce Moskowitz ,MD; Marc Sherman ; Bruce Moskowitz Recurring : No ShowReminder : Yes ReminderMinutes : 15 ReminderT ime: Mon Mar 19 10:45:00 Central Daylight Time 2018 Accepted : No I VA-18-0298-I-000830 Page 1471 of 2i1iof 1380 Document ID: 0.7.1705.1769682 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; (b_)(6_)___ ; Blackburn, Scott R. ; Windom, John H. ; @gmail.com> ; Marc Carolyn@Bruce Moskowitz,MD tlb\/ 6\ Sherman l(b)(6 ) @gmail.com >; Bruce Moskow itz l(b)(6) @mac .com> Cc: Bee: VA EHR Call Subject: Thu Mar 15 201811:23:07 EDT Date: Attachments: l..... StartTime: Mon Mar 19 11:00:00 Central Daylight Time 2018 EndTime: Mon Mar 19 11:45:00 Central Daylight Time 2018 Location : !(b)(6) Invitees: l(b)(6l IBlackburn, Scott R.; Windom , John H.; Carolyn@Bruce Moskowitz ,MD; Marc Sherman; Bruce Moskowitz Recurring: No ShowReminder: Yes ReminderMinutes: 15 ReminderTime: Mon Mar 19 10:45:00 Central Daylight Time 2018 Accepted : Yes AcceptedTime: Thu Mar 15 10:52:00 Central Daylight Time 2018 I VA-18-0298-I-000831 Page 1472 of 2i1~ of 1380 Document ID: 0.7.1705.1356795 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; ._l (b_)(_6)--= ,........,,....,......-_. ; Blackburn, Scott R. ; Windom, John H. ; Carolyn@Bruce Moskowitz,MD !(bl(6l @gmail.com>; Marc Sherman l{b}/6} 1@gmail.com>; Bruce Moskowitz l(b)(6) @mac.com> Cc: Bee: Subject: VA EHR Call Thu Mar 15 201811:23:07 EDT Date: Attachments: StartTime: Mon Mar 19 11 :00:00 Central Daylight Time 2018 EndTime : Mon Mar 19 11 :45:00 Central Daylight Time 2018 Location : l(b)(6) lnvitees: l(b)(6) !Blackburn, Scott R.; Windom , John H.; Carolyn@Bruce Moskowitz,MD; Marc Sherman; Bruce Moskowitz Recurring: No ShowReminder: No Accepted : Yes AcceptedTime: Thu Mar 15 10:52:00 Central Daylight Time 2018 I VA-18-0298-I-000832 Page 1473 of 2i1~of 1380 Document ID: 0.7.1705.1219379 VAC IO Executive Schedule From: (b)(6) ; Blackburn, Scott R. ; Windom, John H. ; Caro lyn Bruce Moskowitz.MD l(b)(6) @gmail.com>; Marc Sherman( b)(6) gmail.com>; Bruce Moskowitz b 6 Cc: Bee: Subject: Date: Attachments: VA EHR Call Thu Mar 15 2018 11:23:05 EDT VA-18-0298-I-000833 Page 1474 of 2i1~of 1380 Document ID: 0.7.1705.1219373 From: Bruce Moskowitz l(b)(6) @mac .com> @gmail.com> Marc Sherman !(b)(6) To: l(b)(6) !; Blackburn , Scott R. ; IP (b)(6) frenchangel59 .com>; Laura Perlmutter l(b)(6) @gmail.com>; Windom, John H. ; (b)(6) Bee: Re: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up Subject: Thu Mar 15 201811:10:19 EDT Date: image001.jpg Attachments: Thank you just received Sent from my iPad Bruce Moskowitz M.D. On Mar 15, 2018, at 11 :08 AM, Marc Sherman l~ (b_)(6 _)__ ~ ~gmail.com > wrote: Thank ~ (b)(G) On Mar 15, 2018 8:01 AM, 'l~ (b_)(6 _)_________ ~~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-I-000834 Page 1475 of 2i1iof 1380 Office of Procurement, Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 ~ Mobile: ~l (b_)(6_) ___ 6l___ e-mai1: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(b)(G) l§gmail.com] Sent: Thursday, March 15, 2018 10:54 AM To : Blackburn , Scott R. 6 l_____ Cc: IP; Laura Perlmutter ; Bruce Moskowitz ; l(b)(6 ) !Windom , John H.;~l (b_)(_ Subject: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up Scott and l(b)(G) ~ I I received a document download email 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 VA-18-0298-I-000835 Page 1476 of 2i1~of 1380 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) and we are movin forward. l(b)(6) l(cc'd, our contracting officer) is making sure everyone has the right material. (b)(6) 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 l(b)(6) lwill 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 ! 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 l(b_J(_ l__ We will need you to sign the attached NOA. Please return to .... ~ _.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 ou to the contract and help focus you on the parts where your expertise will be most valuable . (b)(G) (who is the government contrac ting officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask l(b)(6) l(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-I-000837 Page 1478 of 2i1~of 1380 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000838 Page 1479 of 2~~~ of 1380 Document ID: 0.7.1705.1219367 From: Marc Sherman ljb)(6) @gma il.com> l(b)(G) Cc: Blackburn , Scott R. ; IP ~ @frenchange l59.com>; Laura Perlmutte rl(b)(6) l.a}gmail.com>; Bruce Moskowitz l(b)(6) @mac.com>;W indom , John H. ; l(b)(6) l Bee: Subject: RE: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant wi ll set up Date: Thu Mar 15 201811:08:01 EDT Attachments: image001.jpg Thank ~(b)(6) ..... _)(_6)_________ On Mar 15, 2018 8:01 AM, l(b __.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, ~ 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 VA-18-0298-I-000839 Page 1482 of 2i1i of 1380 Mobile :~l (b_)(G _) __ e-mail:~l (b_)(6_) __ ~ ~l @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 [mailto:mbsherman@gmail.com] Sent: Thursday, March 15, 2018 10:54 AM To: Blackburn, Scott R. Cc: IP; Laura Perlmutter ; Bruce Moskowitz ; Truex , Matthew; Windom , John H.; Callaghan, Elizabeth Subject: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up Scott and Matt I received a document download email 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% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper , and Dr. Shretha) and we are moving forward. Matt Truex (cc'd, our contracting officer) is making sure everyone has the right material. Liz (my assistant , cc'd here) will be organizing a few phone calls in 2 steps: VA-18-0298-I-000840 Page 1483 of 2i1iof 1380 Step 1 - Basic orientation to the government cont ract structure. This will be a 30-45 minute orientation so that folks know what they are looking at. John Windom and l(b)(6) lwill host this and clue people into the parts to focus on and parts that are standard government things that are less relevant. This can as be done in groups (ideally) or in one-offs to fit to accommodate people 's busy schedules. ~ already scheduled 2 times in case these work for you . If they do not , she will work with your schedulers to find other times in the next 24-48 hours (sooner the better). * Thursday 8:30-9:1 Sam 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 week. Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest. ~ set these up. ill * 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 !(b)(6) @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn , Scott R. @gmail.com; Bruce Moskowitz; .... l(b_)(_6)___ Cc: IP:!(b)(6) Subject: [EXTERNA L] Re: VA EHR NOA ____.I Windom , John H.; DJS Scott, l(b)(S) land 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 VA-18-0298-I-000841 Pag e 1484 of 2i\~ of 1380 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 , Scot t R. 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) 2) 5 We wi ll need you to sign the attached NOA. Please return to ._l (b_)( _l _ __,l(cc'd). l(b)(S) 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 expertise will be most valuable . l(b)(6) (who 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)( 6 ) 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 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-I-000842 Page 1485 of 2i\~ of 1380 Document ID: 0.7.1705.1219342 From: l(b)(G) j::/o=va/ou=visn 03/cn=rec ipients/cn=v haeastruexm> To: Marc Sherman l(b)(G) ~gmail.com>; Blackburn , Scott R. IP~ frenchan gel59.com>; Laura Cc: @gmail.com>; Bruce Moskowitz Perlmutte d(b)(G) j(b)(G) @mac.com> ; Windom, John H. ; (b)(G) /o=va/ou=exchange administrat ive group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: RE: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant wi ll set up Date: Thu Mar 15 201811:01:08 EDT Attachments: image001.jpg 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. Thank s, (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 (b_)(G _)___ Mobile : l~ e-mai l: "'"l (b...;.. )('6) ""'___ ~ _,@va.gov VA-18-0298-I-000843 Page 1489 of 2i\~ of 1380 "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." @gmail.com] From: Marc Sherman l(b)(6) Sent: Thursday, March 15, 2018 10:54 AM To: Blackburn, Scott R. Windom , John H.; l.... (b_)(_6)_____ Cc: IP; Laura Perlmutter ; Bruce Moskowitz; l(b)(6) Subject: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up I Scott and l(b)(6) _. I 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% participation (Stephanie Reel, Stan Huff, Jon Manis, Dr. Ko , Dr Karson , Dr. Cooper , and Dr. Shretha) l(cc'd, our cont racting officer) is making sure everyone has the and we are moving forward. l(b)(6) right material @llfil] 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 l(b)(6) lwill 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. l(b)(Gjhas already scheduled 2 times in case these work for you . If they do not , she will work with your schedulers to find other times in the next 24-48 hours (sooner the better). VA-18-0298-I-000844 Page 1490 of 2i1iof 1380 * 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.j(b)(6)tNill set these up. * Cl Os (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(b)(6) @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn , Scott R. 6)____ @gmail.com ; Bruce Moskowit z;_l (b_)(_ Cc: IP; l(b)(6) Subject: [EXTERNAL] Re: VA EHR NOA 1Windom , John H.; DJS ll Scott ,l(b)(6 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 vers ion by me of the amended NOA. Thanks and happy to help as requested. VA-18-0298-I-000845 Pag e 1491 of 2i\~ of 1380 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 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. We will need you to sign the attached NOA. Please return to ~l (b_)(6 _)_~ 1) 2) kcc'd) . l(b)(S) 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 expertise will be most valuable j(b)(6) l(who is the government contracting officer) and John Windom (who is our EHR leader) will lead this from our side . I will ask l(b)(6) !(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 hop ing 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-I-000846 Page 1492 of 2i1i of 1380 Document ID: 0.7.1705.502879 From: l(b)(S) l Marc Sherman l(b)(6) ~gmail.com>; To: Blackburn , Scott R. l~ @frenchan el59.com>; Laura Cc: Perlmutter b 6 gmail.com>; Bruce Moskowitz (b)(6) mac.com> ; Windom, John H. j(b)(6) 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) l(cc'd, our contracting officer) is making sure everyone has the and we are moving forward. l(b)(6) right materia lJ(b)(6) Kmy 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 l(b)(6) lwill host this and clue people into the parts to focus on and parts that are standard government things that are less relevant. This can as be done in groups (ideally) or in one-offs to fit to accommodate people 's busy schedules ~ VA-18-0298-I-000848 Page 1497 of 2i1iof 1380 already scheduled 2 times in case these work for you . If they do not, she will work with your schedulers to find other times in the next 24-48 hours (sooner the better). Thursday 8:30-9: 1Sam 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 ear ly next week. Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest.l(b)(G)lwill 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(b)(G) lg}.gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn , Scott R. Cc: IP; !(b)(6) @gmail.com; Bruce Moskowitz ;._l (b_)(G _)___ Subject: [EXTERNAL] Re: VA EHR NOA ___,I Windom, John H.; DJS Scott, l(b)(G) land 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. VA-18-0298-I-000849 Page 1498 of 2i1iof 1380 Marc On Tu e , 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 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 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 wi ll need you to sign the attached NOA . Please return to Matt Truex (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 you to the contract and help focus you on the parts where your expertise will be most valuab le. l(b)(6) (who is the government contract in officer) and John Windom (who is our EHR leader) wi ll lead this from our side . I will as (b)(6) (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 . I We have also connected with 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-I-000850 Page 1499 of 2iY6 of 1380 Document ID: 0.7.1705.1769673 From: Blackburn, Scott R. (b)( 6) Cc: Bee: FW: [EXTERNAL] EMR documents Subject: Thu Mar 15 2018 10:55:53 EDT Date: 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; l(b)(G) @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-I-000851 Page 1503 of 2i~ of 1380 Document ID: 0.7.1705.502863 From: Blackburn , Scott R. To: (b)(6) ~----~ From: Blackburn, Scott R. Cc: l~ frenchan el59.com>; Laura Perlmutte (b)(6) gmail.com>; Bruce Moskowitz (b)(6) mac.com>; l(b)(6) l; Windom, John H. ; (b)(6) Bee: Subject: [EXTERNAL] Re: VHA EHR - 2 calls that my assistant will set up Date: Thu Mar 15 2018 10:53:37 EDT Attachments: Scott and l(b)(6) I received a document download email 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% 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 moving forward. l(b)(6) right material. liliTifilkmy 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 l(b)(6) lwill 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 l(b)(G)lhas already scheduled 2 times in case these work for you . If they do not, she will work with your schedulers 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 VA-18-0298-I-000853 Page 1505 of 2i~ of 1380 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.~ set these up. ill ********* 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 !{b)(G) @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. Cc: IP; i(b)(G) @gmail.com; Bruce Moskowitz; l.__ (b_)(G _)___ Subject: [EXTERNA L] Re: VA EHR NOA ___,I Windom, John H.; DJS Scott, l(b)(Gl land 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-I-000854 Page 1506 of 2iYa of 1380 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) l(b_)(_S)__ We wi ll need you to sign the attached NOA. Please return to .... 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 (who is the government contracting officer) and John expertise will be most valuab le. l(b)(6) l(cc'd) here to help Windom (who is our EHR leader) will lead this from our side . I will ask l(b)(6) 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 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-I-000855 Page 1507 of 2iYs of 1380 Document ID: 0.7.1705.502862 Marc Sherman l(b)(6) From: @gmail.com> To: Blackburn, Scott R. Cc: IPl(b)( l@frenchangel59.com>; Laura Perlmutte rj(b)(6) :gmail .com>; Bruce Moskowitz l(b)(6) mac .com> ; l(b)(6) ;l(b)(6) 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 ) l(cc'd, our contracting officer) is making sure everyone has the and we are moving forward. l(b)(6) right materia lj(b)(6) Kmy 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 l(b)(6) lwill 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 .l(b)(Glhas already scheduled 2 times in case these work for you . If they do not, she will work with your schedulers to find other times in the next 24-48 hours (sooner the better). Thursday 8:30-9: 15am ET - Stephanie Reel confirmed VA-18-0298-I-000856 Page 1508 of 2i~ of 1380 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 ear ly next week . Both 90 minutes each. We are aiming for Monday , Tuesday or Wednesday at the latest J(b)(G)lwill set these up . C IOs (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: Mar c Sherm a n l(b)(6) !@gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To : Blackburn , Scott R. 6l___ l@gmail.com; Bruce Moskowitz ;~l (b_)(_ Cc: IP; l(b)(6) Subject: [EXTERNAL] Re: VA EHR NDA ~I Windom , John H.; DJS Scott, l(b)(G) land 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 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 NDA for Bruce and Ike to sign, and 3.a signed version by me of the amended NDA. Thanks and happy to help as requested. Marc VA-18-0298-I-000857 Page 1509 of 2im, of 1380 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(cc'd) . 1) We will need you to sign the attached NOA . Please return to ~l (b_)(6 2) Matt 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 valuable . (b)(6) Windom (who is our EHR leader) will lead this from our side . I will ask (b)(6) (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-I-000858 Pa ge 1510 of 2iYs of 1380 Document ID: 0.7.1705.1219329 Bruce Moskowitz From: l(b)(6) @mac.com> To: Windom, John H. ; Blackburn , Scott R. I (b)( frenchangel59.com>; Cc: gmail.com l,.... (b-)(-6)-----. @gmail.com> (b)(6) Bee: Subject: [EXTERNAL] EMR documents Date: Thu Mar 15 2018 10:51 :08 EDT Attachments: , 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-I-000859 Page 1511 of 2i~ of 1380 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 ----,_ - ---------.. From: Bruce Moskowitz l~b)(6) @mac.com] Sent: Thursday, March 15, 2018 9:52 AM To: Blackburn, Scott R. @gmail.com ; O'Rourke, Peter M. Cc: IP; !ibl/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-I-000860 Page 1512 of 2i1i of 1380 > * 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 ,....k b-)(-6)---------. Lcv,mac.com] > 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-I-000861 Page 15 13 of 2i1~of 1380 Document ID: 0.7.1705.982785 From: Bruce Moskowitz !iblf6l @mac .com> Blackburn , Scott R. l~ frenchangel59.com>; Cc: !(b)(6) l@gmail.com ~l (b-)(-6)~-~ @gmail.com>; 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 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 central 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 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 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-I-000862 Page 15 14 of 2i1~of 1380 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 Moskowit ~(b)(6 ) @mac.com] > 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-I-000863 Page 1515 of 2i1~of 1380 Document ID: 0.7.1705.502783 From: Bruce Moskowitz l(b)(6) l@mac.com> Blackburn , Scott R. IP (b)( frenchangel59.com>; Cc: (b-)(-6)~-~ @gmail.com>; O'Rourke , Peter M. (b)(6) gmail.com l~ 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 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 techno logy 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 , thank s for raising this . Below is what I learned about what we have for intensive care units interacting with a central 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 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 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 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-I-000864 Page 15 16 of 2i1iof 1380 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(b)(6) l@mac.com] > 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-I-000865 Page 15 17 of 2i1~of 1380 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-I-000866 Page 151 8 of 2~e~ of 1380 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-I-000867 Page 1519 of 2~e~ of 1380 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-I-000868 Page 1520 of 2~ 8~of 1380 -----Original Message----~---------~ From: Bruce Moskowitz l(b)( 6 ) 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-I-000869 Page 1521 of 2i1i of 1380 Document ID: 0.7.1705.502761 Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Thu Mar 15 2018 09:24:22 EDT Attachments: 1> Bruce , thanks for raising this . Below is what I learned about what we have for intensive care units interacting with a central 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 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. •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(b)(6) 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 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 VA-18-0298-I-000870 Page 1522 of 2iWJ of 1380 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-I-000871 Page 1523 of 2~ 7~of 1380 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-I-000872 Page 1524 of 2~ 7~of 1380 ******* 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-I-000873 Page 1525 of 2~ 7~of 1380 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-I-000874 Page 1526 of 2~ 7~of 1380 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)-------~ 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-I-000875 Page 1527 of 2i1/s of 1380 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 so lution . This so lution has the capability to configure dashboard views to enable monitoring of high acuity areas, spec ifically around performance and patien t care. This capab ility is included in the scope of the Cerne r acquisition as the Critica l Care System , Cerner Apache Outcomes so lution and End User License Agreement. Does th is capab ility 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 ca re process . Th is so lution 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: Trad itional centra l mon itoring systems as are used in te lemetry, exist w ith in 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. Howeve r, the acquis ition includes integ ration of this capability . In addition to these monitoring capabil ities, CareAware Patient Flow, which is Cerner's capacity management so lution that helps to operationalize pat ient care activities such as room cleaning offers spec ific dashboards that ca n be centralized to support a ce ntral command ce nter model. From: Windom, John H. Sent: Wednesday , March 14, 2018 7:00 PM VA-18-0298-I-000876 Page 1528 of 2~ 7~of 1380 To: Zenooz , Ashwini; Blackburn, Scott R.; Short , John (VACO) Subject: RE: [EXTERNAL] EMR calls I would 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-I-000877 Page 1529 of 2~ 7~of 1380 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(b -)(-6)-------~ 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 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-I-000878 Pa ge 1530 of 2i1/s of 1380 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-I-000879 Page 153 1 of 2~ 7~of 1380 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-I-000880 Page 1532 of 2~ 8~of 1380 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-I-000881 Page 1533 of 2~ 8~of 1380 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)(S) Sent: Wednesday , March 14, 2018 12:18 PM To: Blackburn, Scott R. Subject: [EXTERNA L] EMR calls l@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-I-000882 Page 1534 of 2i1~of 1380 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-I-000883 Page 1535 of 2~ 8~of 1380 Document ID: 0.7.1705. 152 1240 From: Windom, John H. To: Zenooz, Ashwin i ; Blackburn , Scott R. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] EMR calls Date: Wed Mar 14 2018 19:00:18 EDT Attachments: I wou ld 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: [EXTERNA L] 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: [EXTERNA L] 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-I-000884 Page 1536 of 2~ 8~of 1380 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-I-000885 Page 1537 of 2~ 8~of 1380 Subject: FW: [EXTERNAL] EMR calls -----Original Message---- ,_ - ------------. From: Bruce Moskowitz l(b)( 6 ) 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-I-000886 Page 1538 of 2i1iof 1380 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-I-000887 Page 1539 of 2~ 8~of 1380 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----.-----------, From: Bruce Moskowitz l(b)(6) 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-I-000888 Page 1540 of 2i1iof 1380 Sent from my iF?ad Bruce Moskowitz MD. Page 1541 of 23% of 1380 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-I-000890 Page 1542 of 2~ 9~of 1380 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)( 6 ) 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-I-000891 Page 1543 of 2i1~of 1380 Document ID: 0.7.1705.1218251 From: Windom, John H. !(b)(6) !; 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) I From: l(b)(6) 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 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 VA-18-0298-I-000892 Page 1544 of 2i1~of 1380 Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 ~ Mobile: ~l (b_)(6 _)___ e-mail: j""" (b""" )(-" 6)___ .... @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 To: l(b)(6) 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(b)(6) 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-I-000893 Page 1545 of 2i1~of 1380 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 (b_)(6_) __ Mobile: l~ e-mail: ~l (b_)(6_) __ ~ ~l @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." I From: l(b)(6) Sent: Tuesday , March 13, 2018 2:17 PM To: Blackburn, Scott R.; Windom, John H.; Foster , Michele (SES) VA-18-0298-I-000894 Page 1546 of 2i1iof 1380 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 (b_)(_G)___ Mobile: 1..... ~ e-mail: ..... l(b_)(_6)___ ..... @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(b_)(_G)___ ___, 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? VA-18-0298-I-000895 Page 154 7 of 2i1~of 1380 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 Procurement , Acquisition and Logistics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile : ._l (b_)(_6 l___ e-mail: ..... l(b_)(_6)___ _. ....., @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: Blackburn, Scott R. Sent: Tuesday , March 13, 2018 11 :41 AM To: l(b)(6) Windom, John H.; Foster, Michele (SES) 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 VA-18-0298-I-000896 Page 1548 of 2i1iof 1380 right way so lean ing 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 perspect ives is always good - especially on a contract of this significance and magnitude). Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000897 Page 1549 of 2~ 9~of 1380 Document ID: 0.7.1705.1218237 From: l(b)(6) l To: Windom, John H. ; Blackburn , Scott R. Cc: Foster , Michele (SES) Bee: RE: any other NDAs come in? Subject: Wed Mar 14 2018 13:24:21 EDT Date: image001.jpg Attachments: , John - To some extent , yes, however, in instances where VA is having specific individua ls prov ide 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 Log istics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :~ e-mail: L______b va.gov VA-18-0298-I-000898 Page 1552 of 2i1i of 1380 "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: Windom, John H. Sent: Wednesday, March 14, 2018 12:48 PM Blackburn , Scott R. To: l(b)(6) 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(b)(6) 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, 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) VA-18-0298-I-000899 Page 1553 of 2i1iof 1380 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: ~ va.gov "For Internal VA Use Only - Working Draft, Pre-Decisiona l, Deliberat ive 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-mail or telephone (732) 440 -965 0, and permanent ly delete the origina l and any copy of any e-mail and any printout thereof." I From: l(b)(G) 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. Ree l, Mr. Perlmutter and Mr. Sherman access to the RFP files via the Army's SAFE site. Thanks, (b)(6) Contracting Officer VA-18-0298-I-000900 Page 1554 of 2ibiof 1380 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 :~ e-mail: [_w va.gov "For Internal VA Use Only - Working 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 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-mail or telephone (732) 440 -965 0, and permanent ly delete the origina l and any copy of any e-mai l and any printout thereof." I From: l(b)(6) 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 NOA 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 Techno logy Acquisition Center 23 Christopher Way VA-18-0298-I-000901 Page 1555 of 2ib~of 1380 Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile ~ e-mail: L_______l@ 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 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 origina l and any copy of any e-mai l and any printout thereof." From: Blackburn , Scott R. Sent: Tuesday , March 13, 2018 11 :41 AM To:l(b)(6) Windom, John H.; Foster, Michele (SES) 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 C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000902 Page 1556 of 2ib~of 1380 Document ID: 0.7.1705.501856 From: j(b)(6 ) 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 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 Mobile :Db)(G) e-mail: va.gov VA-18-0298-I-000903 Page 1560 of 2ib~of 1380 "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 Blackburn , Scott R. To: l(b)(6) Cc: Foster, Michele (SES) Subject: RE : any other NDA s come in? I NDA s are a moot point after the public posting, correct? Jw Sent with Good (www.good.com) I From: l(b)(6) 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, 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, ~ VA-18-0298-I-000904 Page 1561 of 2ibiof 1380 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 Mobil_ejl' ll ' l I e-mai l:~-----~ l@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 confident ial 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-mail or telephone (732) 440-9650 , and permanently delete the original and any copy of any e-mai l and any printout thereof. " I From:l(b)(6) Sent Tue sday, 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 prov iding Ms. Reel, Mr. Perlmutter and Mr. Sherman access to the RFP files via the Army's SAFE site. Thanks, l(b)(6) I VA-18-0298-I-000905 Page 1562 of 2ib~ of 1380 l(b)(6) Contracting 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 :~ e-mail: L______h 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 de lete the original and any copy of any e-mail and any printout thereof. " I From: l(b)(6) 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 NOA 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 Techno logy Acquisition Center VA-18-0298-I-000906 Page 1563 of 2ibiof 1380 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :~ e-mail: ~ va.gov "For Internal VA Use Only - Working 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 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 de lete the origina l and any copy of any e-mai l and any printout thereof." From: Blackburn, Scott R. Sent: Tuesday , March 13, 2018 11 :41 AM Windom, John H.; Foster, Michele (SES) To: l(b)(6) Subject: any other NDAs come in? I Let me know if/when they do. The Secretary is monitoring very close ly 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 C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000907 Page 1564 of 2ib~of 1380 Document ID: 0.7.1705.501278 From: Blackburn , Scott R. To: Stan Huff (b)(6) imail.org> Cc: Windom , John H. ; (b)(6) ; l(b)(6) Bee: Subject: RE: VA EHR Date: Wed Mar 14 2018 12:56: 12 EDT Attachments: Thanks so much, Stan! From: Stan Huffl(b)(6) @imail.org] Sent: Wednesday, March 14, 2018 11 :52 AM To: Blackburn, Scott R. 5)_____ Cc: Windom , John H.; l~ (b-)(6 - )---~I Foster, Michele (SES) :._l (b_)(_ Subject: [EXTERNAL] RE: VA EHR _. 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 j(b)(6) @ imail.org> ;.... l(b_)(_6)_________ Cc: Windom, John H.,..,_ Michele (SES) ; l(b)(6) Subject: RE: VA EHR ........ @ .._ v_a_..g .._ o~v>; Foster , @va .gov> Stan: VA-18-0298-I-000908 Page 1568 of 2ibiof 1380 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) 6)__ We will need you to sign the attached NOA. Please return to,.....l (b_)(_ 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 ou to the contract and help focus you on the parts where your expertise will be most valuable . (b)(6) 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)(6) l(cc'd) here to help set up a time. Thanks again! Scott From: Stan Huff l(b)(6) @imail.org] Sent: Monday , March 12, 2018 4:34 PM To : Blackburn, Scott R. Subje ct: [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 enlis t 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-I-000909 Page 1569 of 2ibiof 1380 Thanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000910 Page 1570 of 2~m of 1380 Document ID: 0.7.1705.1218221 From: Blackburn , Scott R. Stan Huff To: Windom , John H. ; l(b)(6) 03/cn=recipients/cn=vhaeastruexm>; Foster, Michele (SES) b...,. )(6 .... l __ _. ;.._l( Bee: Subject: RE: VA EHR Date: Wed Mar 14 2018 12:56:12 EDT Attachments: I Thanks so much, Stan! From: Stan Huffl(b)(6) @imail.org) Sent: Wednesday, March 14, 2018 11 :52 AM To: Blackburn, Scott R~------~ 6)_____ Cc: Windom , John H.;l(b)(6) !Foster , Michele (SES) ; .... l(b_)(_ Subject: [EXTERNAL] RE: VA EHR __, 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 l(b)(6) @ imail.org > Cc: Windom, John H.; l(b)(6) Michele (SES) ; ...:.k b-= }/=6 }============..::: Subject: RE: VA EHR l@va.gov>; Foster , ~::..:..::'...::....:.., @va.g ov> 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. VA-18-0298-I-000911 Page 1571 of 2i~~ of 1380 6)__ We will need you to sign the attached NOA. Please return to .... l(b_)(_ 1) 2) ...., l(cc'd). l(b)(G) 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 expertise will be most valuable . !(b)(6) 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)(6) l(cc'd) here to help set up a time. I Thanks again! Scott From: Stan Huff l(b)(6) (@,imail.org) 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 , 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-I-000912 Page 1572 of 2i~~ of 1380 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000913 Page 1573 of 2~m of 1380 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-I-000914 Page 1574 of 2~l~of 1380 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-)(-6)-------~ 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 monitor ing system? Currently all major institutions have a command and control center staff that monitors intensive care units located in different hospita ls 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-I-000915 Page 1575 of 2i~~ of 1380 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-I-000916 Page 1576 of 2~m of 1380 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)(6) 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 hospita ls 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-I-000917 Page 1577 of 2i~~ of 1380 Document ID: 0.7.1705.1218208 From: Zenooz, Ashwini To: Windom, John H. ; Blackburn , Scott R. ; Short, John (VACO) Cc: Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 12:54:18 EDT Date: 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-)(-6)-------~l Sent: Wednesday, March 14, 2018 12:18 PM To: Blackburn, Scott R. @mac.com] VA-18-0298-I-000918 Page 1578 of 2i~i of 1380 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-I-000919 Page 1579 of 2~m of 1380 Document ID: 0.7.1705.1218204 From: Windom, John H. To: Blackburn, Scott R. ; Short , John (VACO) ; Zenooz, Ashwini Cc: Bee: RE: [EXTERNAL] EMR calls Subject: Wed Mar 14 2018 12:50:28 EDT Date: 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----~-----------. From: Bruce Moskowitz l(b)(6) 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-I-000920 Page 1580 of 2i1iof 1380 Document ID: 0.7.1705.1218202 Windom , John H. l(b)(6) 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 12:47:37 EDT Attachments: image001. jpg NDAs are a moot point after the public posting, correct? Jw Sent with Good (www.good.com) I From: l(b)(6) 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, I have received NDAs for all individuals except Dr. Ko and Dr. Scott. NDAs are in hand for Dr. Cooper, Dr. Huff , Dr. Moskow itz , Mr. Sherman, Mr . Perlmutter, and Ms. Reel. Those with signed NDAs have all been sent a link to the RFP files. Thanks , (b)(6) VA-18-0298-I-000921 Page 1581 of 2i1~of 1380 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 Mobil.e:l(b)(G) e-mail: ._ _____ I _.@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." I From: l(b)(6) 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 access to the RFP files via the Army 's SAFE site. Thanks, (b)(6) VA-18-0298-I-000922 Page 1582 of 2i1~ of 1380 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 , 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 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_)(_ G)____ ~ 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 NOA 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 VA-18-0298-I-000923 Page 1583 of 2i1~of 1380 Eatontown, New Jersey 07724 Office: 732-440-9650 Mobil.e:lio)(GJ I e-mail: ~-----~ @-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-mail 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: Tuesda March 13, 2018 11 :41 AM To: (b)(6) Windom, John H. ; Foster, Michele (SES) SubJect: any ot er DAs come in? 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 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 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-I-000924 Page 1584 of 2i1iof 1380 Document ID: 0.7.1705.1218287 From: l(b)(6) ! To: Blackburn, Scott R. Cc: 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 Mobil.e1(b)(G) I e-mail: ...... -----J ~va.gov VA-18-0298-I-000925 Page 1588 of 2i1~of 1380 "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_)(6_) ___ ~ 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 Mobil.el(b)(G) I e-mail: ..... ----- b va.gov = VA-18-0298-I-000926 Page 1589 of 2i1iof 1380 "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. " (b_)(_6)___ ___, From: ,__l 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 NOA 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: ~ 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 VA-18-0298-I-000927 Page 1590 of 2i1~of 1380 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 de lete the origina l and any copy of any e-mai l and any printout thereof." From: Blackburn , Scott R. Sent: Tue sday, March 13, 2018 11 :41 AM To: l(b)(6) !Windom , John H.; Foster, Michele (SES) Subject: any other NDAs come in? 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-I-000928 Page 1591 of 2i1iof 1380 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 ----From: Bruce Moskowitz ~ l(b -l(-6l-------~ 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-I-000929 Page 1594 of 2i1iof 1380 Document ID: 0.7.1705.501148 Bruce Moskowitz From: l@mac.com> Blackburn , Scott R. l(b)(6) 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 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-I-000930 Page 1595 of 2i1iof 1380 Document ID: 0.7.1705.1218135 From: Stan Huff l(b)(G) laJimail.org> To: Blackburn, Scott R. Cc: Windom , John H. ; (b)(G) ; Foster, Michele (SES) ;l(b)(G) l(b)(G) 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 l(b)(G) @imail.org> Cc: Windom, John H.; l(b)(G) Michele (SES) ;l..... (b.... )(-6)---------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 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) (b_)(G _)_~l We will need you to sign the attached NOA. Please return to ~l (cc'd) . l(b)(G) 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 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 (cc'd) here to help set up a time. you. I will ask l(b)(G) I VA-18-0298-I-000931 Page 1596 of 2i1~of 1380 Thanks again! Scott From: Stan Huff l(b)(G) @imail.org] 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 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-I-000932 Page 1597 of 2i1~of 1380 Document ID: 0.7.1705.1769086 From: VAC IO Executive Schedule To: VACIO Executive Schedule ; Windom , John H. ; Blackburn , Scott R. ;._l ; Carolyn@Bruce Moskowitz .MD (b)(6) gma il.com> ; Bruce Moskowitz (b)(6) 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(b)(6) Invitees : Windom , John H.; Blackburn , Scott RJb )(6) Carolyn@Bruce Moskowitz.MD; Bruce 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 Central Daylight Time 2018 I I VA-18-0298-I-000933 Page 1602 of 2i1~ of 1380 Document ID: 0.7.1705.1218106 From: ~ !(b_)(_G)_____ ~l To: Blackburn, Scott R. ; ._l Windom , John H. Bee: Subject: RE: [EXTERNAL] RE: VA EHR Date: Wed Mar 14 2018 07:40:49 EDT Attachments: Good morning, I believe we have everyone scheduled for tomorrow here is the breakdown : 8:30AM Reel Ko 11:30AM Huff Karson Cooper I have yet to hear back from the three folks you emailed last night. Thanks , l(b)(6) I From: Blackburn, Scott R. Sent: Tuesday, March 13, 2018 11 :07 PM To: l(b)(G) I Cc: Windom, John H. Subject: FW: [EXTERNAL] RE: VA EHR VA-18-0298-I-000934 Page 1604 of 2i1iof 1380 Importance: High 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. 5 (b_)(_ l_____ From: Cooper, Leslie T. , M.D. ~l Sent: Tuesday , March 13, 2018 11 :04 PM To: Blackburn, Scott R. Cc: l(b)(6) Subject: Re: [EXTERNAL] RE: VA EHR ~ @mayo.edu] 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(b)(S) i(cc'd here) will send you the latest package of material to review . 2) 1£iillfil]also cc'd here) will reach out to you to schedule some time this week so that l(b)(6) lteam can orient you to wha ~(b)(6) lwill 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 Matt can walk you through what sections to look at and what you can ignore. Thanks again! Scott 6l_____ l(b_)(_ From: Cooper, Leslie T. , M.D . ...... Sent: Tuesday , March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR __. @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 VA-18-0298-I-000935 Page 1605 of 2i1~of 1380 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-I-000936 Page 1606 of 2~j~ of 1380 Document ID: 0.7.1705.500811 l(b)(G) l To: Blackburn, Scott R. ; ~l Bee: Subject: Date: Attachments: bbf83ea 18 RE: [EXTERNAL] RE : VA EHR Wed Mar 14 2018 07 :40:49 EDT Good morning , I believe we have everyone scheduled for tomorrow here is the breakdown : 8 :30AM Reel Ko 11:30AM Huff Karson Cooper I have yet to hear back from the three folks you emailed last night. Thanks, Liz From: Blackburn, Scott R. Sent: Tuesday , March 13 , 2018 11 :07 PM VA-18-0298-I-000937 Page 1607 of 2i1~of 1380 To: l(b)(6) Cc: Windom, John H. Subject: FW: [EXTERNAL] RE: VA EHR Importance : High 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. 6l_____ From: Cooper , Leslie T. , M.D . ._l (b_)(_ Sent: Tuesday , March 13, 2018 11 :04 PM To: Blackburn, Scott R. Cc: l(b)(6) Subject: Re: [EXTERNAL] RE: VA EHR _,@mayo.edu] Tomorrow or next Thur sday? 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(b)(6) k c'd here) will send you the latest package of material to review . 2) l(b)(6) [also cc'd here) will reach out to you to schedule some time this week so tha~(b)(6) lteam can orient you to what Matt 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 tha (b)(6) can walk you through what sections to look at and what you can ignore. Thanks again! Scott 6)_____ From: Cooper, Leslie T. , M.D .._l (b_)(_ Sent: Tue sday, March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR _. raJmayo.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 VA-18-0298-I-000938 Page 1608 of 2i1iof 1380 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 Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-I-000939 Page 1609 of 2~1~ of 1380 Document ID: 0.7.1705.1769056 From: Blackburn , Scott R. To: Myklegard, Drew ; ~l (b_)(_6l___ 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: l(b)(6) !Blackburn , Scott R. Subj ect: RE : [EXTERNAL] Fwd : EMR Where are we with Dr. Moskowitz? Sent with Good (www.good .com) (b_)(_ 6)___ ~ From: ~l 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)(G) I Sent with Good (www.good .com) VA-18-0298-I-000940 Page 1610 of 2i1iof 1380 From: Myklega rd, Drew Sent: Tuesday, March 06, 2018 6:02:25 AM To: Blackburn, Scott R.;l(b)(6) 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 To: l(b)(6) @va.gov >, "Myklegard, Drew" Subject: FW: [EXTERNAL] Fwd: EMR 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-I-000941 Page 161 1 of 2i\~ of 1380 Begin forwarded message: @mac.com> From: Bruce Moskowitz l(b)(6) Date: March 5, 2018 at 6:49:58 AM EST To: (b)(6) gmail.com, (b)(6) reagan.com (b-)(-6)----, Cc: (b)(6) @gmail.com, IP r,x5> @frenchangel59.com> ,.-l Subject: EMR @gma il.com I would like to underscore the importa nce 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 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-I-000942 Pa ge 1612 of 2i\~ of 1380 Document ID: 0.7.1705.500720 From: Blackburn , Scott R. To: Myklegard, Drew ; (b)(6) (Disabled) Date: Tue sday, March 6 1 2018 at 5:42 AM @va.gov> , "Myklegard , Drew" To : l(b)(6) Subject: FW: [EXTERNAL] Fwd: EMR 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-I-000944 Page 1614 of 2i1iof 1380 Begin forwarded message: From: Bruce Moskowitz l(b)(6) @mac .com> Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) @gmail.com , (b)(6) reagan .com Cc j(bl{6l @gma ii.com, IP Cb>c5>@frenchangel 59.com> ,,_l (b-)(-6)--. Subject: EMR @gma il.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-I-000945 Pa ge 1615 of 2i\~ of 1380 Document ID: 0.7.1705.1518229 From: Myklegard, Drew To: (b)(6) /o=va/ou=exchange adm inistrative group (fydibohf23spdlt) /cn=recipients/cn=ricci .mulligan> ; Blackburn, Scott R. Cc: Bee: RE: [EXTERNAL] Fwd : EMR Subject: Tue Mar 13 2018 23:56:51 EDT Date: Attachments: Where are we with Dr. Moskowitz? Sent with Good (www.good .com) l(b_)(6 _)___ __, From: ..... Sent: Tue sday , March 06 , 2018 10:01 :05 AM To: Myklegard, Drew; Blackburn , Scott R. Subj ect: RE : [EXTERNAL] Fwd : EMR Agree , when ?l(b)(6) I Sent with Good (www.good .com) From: Myklegard , Drew Sent: Tue sday , March 06, 2018 6:02:25 AM To: Blackburn, Scott R.; l(b)(6) 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: VA-18-0298-I-000946 Page 1616 of 2i1iof 1380 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: Tuesday, March 6, 2018 at 5:42 AM To:l(b)(6) @va.gov>, "Myklegard, Drew" Subject: FW: [EXTERNAL] Fwd: EMR 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: @mac.com> From: Bruce Moskowitz l(b)(6) Date: March 5, 2018 at 6:49 :58 AM EST @reagan.com .------, To:l(b)(6) @gmail.com, !/bl/6l Cc: ! l@frenchangel59 .com> ,l(b)(6) Subject: EMR l@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 . VA-18-0298-I-000947 Pag e 1617 of 2i\~ of 1380 Sent from my iPad Bruce Moskowitz MD. Page 1618 of 231901? 1380 Document ID: 0.7.1705.500671 From: Blackburn, Scott R. l(b)(6) I; ~l Windom , John H. Bee: Subject: FW: [EXTERNAL] RE: VA EHR Date: Tue Mar 13 2018 23:07:00 EDT 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. (b_)(-6)_____ From: Cooper, Leslie T. , M.D._l Sent: Tuesday , March 13, 2018 11 :04 PM To : Blackburn, Scott R. Cc: i(b)(6) Subject: Re: [EXTERNAL] RE: VA EHR ~ @ ..... mayo.edu] 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 . 2) i(b)(6) l(also cc'd here) will reach out to you to schedule some time this week so that l(b)(6) !team can orient you to wha~ 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 Matt can walk you through what sections to look at and what you can ignore. Thanks again! Scott VA-18-0298-I-000949 Page 161 9 of 2i1iof 1380 5 From: Cooper, Leslie T ., M.D .~l (b_)(_l_____ Sent: Tuesday , March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR ~ ~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-I-000950 Page 1620 of 2iY6 of 1380 Document ID: 0.7.1705.1517939 From: Cooper , Leslie T., M.D. l(b)(6) @mayo.edu> To: Blackburn, Scott R. ; .... 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) l(b)(G) l(cc'd here) will send you the latest package of material to review . 2) l(b)(6) [also cc'd here) will reach out to you to schedule some time this week so thatl(b)(6) tteam can orient you to wha~(b)(6) lwill 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( b)(6) can walk you through what sections to look at and what you can ignore. Thanks again! Scott l(b_)(_6l_____ From: Cooper, Leslie T. , M.D ..... Sent: Tuesday , March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR ___. ~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 VA-18-0298-I-000951 Pa ge 162 1 of 2i~ of 1380 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 Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-I-000952 Page 1622 of 2~ 5~of 1380 Document ID: 0.7.1705.500670 From: Cooper, Leslie T., M.D. !{b)(G) @mayo.edu > To: Blackburn, Scott R. Cc: (b)(G) '--,,------,.--.,........,....---,--' ; (b)(G) wrote : Leslie - thank you so much! 2 next steps. 1) l(b)(G) 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 C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000954 Page 1624 of 2~ 5~of 1380 Document ID: 0.7.1705.1768778 From: Blackburn , Scott R. t:t)qmail.com> To: Marc Sherman !lb\16\ frenchangel59.com>; Cc: .----'-----'-"-, gmail .com l(b)(6) @gmail.com>; Bruce Moskowitz l{b)(6) @mac .com>; l(b)(6) !; Windom, John H. ; DJS :l~ (b_)(_ ~ (b)(6) ; Fleck , Robert R. ; Foster, Michele (SES) Bee: VHA EHR - 2 calls that my assistant will set up Subject: Tue Mar 13 2018 17:04:27 EDT Date: 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) and we are moving forward. l(b)(6) l(cc'd, our contracting officer) is making sure everyone has the right mater ialj(b)(6) ~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 l(b)(6) lwill 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 J(b)(G)lhas already scheduled 2 time s in case these work for you. If they do not , she will work with your schedulers 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 j(b)(G)lwill 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 encou raged to jo in) VA-18-0298-I-000955 Page 1625 of 2iYs of 1380 Let me know how this sounds . Thank you again for your support and assistance on this critical matter. Scott From: Marc Sherman l(b)(G) l@gmai l.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. 6)___ @gmail.com; Bruce Moskowitz ;~l (b_)(_ Cc: IP;!(b)(G) Subject: [EXTERNAL] Re: VA EHR NDA ~1Windom , John H.; DJS Scott, l(b)(6 ) land 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 version 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 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-I-000956 Page 1626 of 2i~ of 1380 1) We will need you to sign the attached NOA. Please return to ~l (b_)(6_)_~1 2) l(b)(6) (cc'd). 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 expertise will be most valuable .l(b)(6) l(who is the government contractin officer) and John Windom (who is our EHR leader) will lead this from our side . I will ask (b)(6) (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 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-I-000957 Pag e 1627 of 2im, of 1380 Document ID: 0.7.1705.499893 Blackburn , Scott R. @gmail.com> Marc Sherman l(b)(6) To: Cc: ~-'-----'-"' -<-. frenchangel59.com>; @gmail.com 1(b)(6) l@gmail.com> ; Bruce Moskowitz (b)(6) mac .com>; ~l (b~)(~6)____ ~ ; DJS : l(b)(6) (b)(6) /o=exchangelabs/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=42c421 b369514c52855cd 1d036fe 7b33 i(b)(6) Fleck , Robert R. (OGC) ; 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: I Marc/Bruce/Ike - thank you so much for the prompt replies. I ju st 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 moving forward . l/b}/6} right materia lj(b)(G)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 will host this and clue people so that folks know what they are looking at. John Windom and l(b)(6) 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)(G)lhas already scheduled 2 times in case these work for you . If they do not, she will work with your schedulers to find other times in the next 24-48 hours (sooner the better). I 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 j(b)(Gjwill set these up. VA-18-0298-I-000958 Page 1628 of 2iYs of 1380 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(b)(G) @gmail.com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. Cc: IP: !(b)(6) @gmail.com; Bruce Moskowitz ; ._l (b_)(_6)___ Subject: [EXTERNAL] Re: VA EHR NDA ____.I Windom, John H.; DJS Scott ,l(b)(6) land 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-I-000959 Page 1629 of 2i~ of 1380 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_)(6 _l _ ___,l(cc'd) . 2) Matt 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 . (b)(6) (who is the government contracting officer) and John Windom (who is our EHR leader) will lead this from our side . I will ask l(b)(6) l(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-I-000960 Page 1630 of 2i1iof 1380 Document ID: 0.7.1705.1768777 Blackburn , Scott R. Cooper , Leslie T., M.D. To: (b)(G) @mayo.edu> (b)(G) ; ._l (b_)(_G)___ 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) l(b)(6 ) l(cc'd here) will send you the latest package of material to review . 2) l(b)(G) l(also cc'd here) will reach out to you to schedule some time this week so that l(b)(G)heam can orient you to what l(b)(G) lwill 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 (b)(G) can walk you through what sections to look at and what you can ignore. Thanks again! Scott 6 )_____ From: Cooper, Leslie T. , M.D. ~l (b_)(_ Sent: Tuesday , March 13, 2018 12:43 PM To : Blackburn , Scott R. Subject: Re: [EXTERNAL] VA EHR ~ ka2mayo.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: VA-18-0298-I-000961 Page 1631 of 2i1~of 1380 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-I-000962 Page 1632 of 2~e~ of 1380 Document ID: 0.7.1705.499839 From: Blackburn , Scott R. Coo er, Leslie T., M.D. To: (b)(6l @mayo .edu> Cc: !ib)/6) I : (b)(6) Bee: RE: [EXTERNAL] VA EHR Subject: Tue Mar 13 2018 16:46:42 EDT Date: Attachments: Leslie - thank you so much! 2 next steps. 1) l(b)(6) l(cc'd here) will send you the latest package of material to review . 2) l(b)(6) l(also cc'd here) will reach out to you to schedule some time this week so that l(b)(6) lteam can orient you to what lilii@]w ill 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 l(b)(6) lean walk you through what sect ions to look at and what you can ignore . Thanks again ! Scott From: Cooper, Leslie T. , M.D.,.,__l (b..:..: )(""""6 )______ Sent: Tuesday , March 13, 2018 12:43 PM To: Blackburn, Scott R. Subject: Re: [EXTERNAL] VA EHR =@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. Les lie Cooper Sent from my iPhone On Mar 12, 2018, at 6:55 AM, Blackburn, Scott R. wrote : Dr. Cooper: VA-18-0298-I-000963 Page 1633 of 2i1~of 1380 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-I-000964 Page 1634 of 2~e~ of 1380 Document ID: 0.7.1705.499638 From: Bruce Moskowitz @mac.com> Blackburn, Scott R. l(b)(6) To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Contract review Tue Mar 13 2018 14:53:20 EDT Please call me at 561 3466269 . I will be on call with the doctors and CIO's. Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-000965 Page 1643 of 2i1~of 1380 Document ID: 0.7.1705.1216491 From: l(b)(6) l To: Blackburn, Scott R. ; Windom, John H. ; Foster , Michele (SES) Cc: Bee: Subject: RE: any other NDAs come in? Date: Tue Mar 13 201814:17:15 EDT 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 Log istics Technology Acquisition Center 23 Christopher Way Eatontown, New Jersey 07724 Office: 732-440-9650 Mobile :.... l(b_)(_6 )___ ....., e-mail: .... l(b_)(_6)___ ....., @va.gov VA-18-0298-I-000966 Page 1644 of 2i1iof 1380 "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_)(6_) ___ ~ Sent: Tue sday , 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 :,.,_l (b..:..: )(--'6)___ e-mail: ._l (b_)(_ 6)___ __. _.@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-I-000967 Page 1645 of 2i1~of 1380 From: Blackburn, Scott R. Sent: Tuesday, March 13, 2018 11 :41 AM Windom, John H.; Foster, Michele (SES) To: l(b)(6) 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-I-000968 Page 1646 of 2i1iof 1380 Document ID: 0.7.1705.820305 From: IFLJ @frenchange l59.com> To: Marc Sherman l(b)(6) taJgmail.com>; Blackburn , Scott R. Cc: l(b)(6) ~gm ail.com @gmail.com>; Bruce Moskowitz !(b)(6) @mac .com> ; (b)(6) ; DJS Bee: Subject: [EXTERNAL ] RE: VA EHR NOA Date: Tue Mar 13 2018 14:07:06 EDT Attachments : Perlmutter.E HR NOA v2 mbs.pdf Attached is my signed NOA. Thank you. @gmail.com] From: Marc Sherman l(b)(6) Sent: Tuesday , March 13, 20181 :40 PM To : Blackburn, Scott R. Cc: IP;!(b)(6) @gmail.com ; Bruce Moskowitz ; ..... !(b__ )(_6)___ Subje ct: Re: VA EHR NOA ___,I Windom , John H.; DJS Scott J(b)(G) land 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 vers ion 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: VA-18-0298-I-000969 Page 1649 of 2i1iof 1380 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~)(6 ....;.. )_ ____.l (cc'd) . 2) l(b)(6) Iwill 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 valuab le.l(b)(6) l(who is the government contractin officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask (b)(6) (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-I-000970 Page 1650 of 2iWJ of 1380 Document ID: 0.7.1705.499602 l~ frenchangel59.com> From: To: Marc Sherman l(b)(6) @gmail.com>; Blackburn , Scott R. Cc: (b)(6) gm ail.com · m>; Bruce M2skowjtz (b)(6) mac .com>; l(b)(S ) ~----~ ; 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(b)(6) @gmail. com] Sent: Tuesday , March 13, 2018 1:40 PM To: Blackburn, Scott R. (b_)(_6)___ Cc: IP: l(b)(6) @gmail. com; Bruce Moskowitz; ~l Subject: Re: VA EHR NOA ~1 Windom , John H.; DJS Scott,j(b)(S) land 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 VA-18-0298-I-000971 Page 1654 of 2i1Aof 1380 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. We will need you to sign the attached NOA . Please return to ._l (b_)(6_l _ 1) 2) l(b)(6) _,l (cc'd) . 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 ou to the contract and help focus you on the parts where your expertise will be most valuable . (b)(6) (who is the government contractin officer) and John Windom (who is our EHR leader) will lead this from our side . I will ask (b)(6) (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 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-I-000972 Pa ge 1655 of 2i~ of 1380 Document ID: 0.7.1705.820239 @gmail.com> From: Marc Sherman !ibl/6l Blackburn, Scott R. IP (b)( frenchangel59.com>; Cc: (b)(6) @gmail.com 1(b)(6) @gmail.com> ; Bruce Moskowitz !rb}/6} @mac .com>; l(b)/6) 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 J(b)(6) land 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-lin e 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 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 poss ible for you. Here are 3 next steps. 1) (b_)(_6)___ We will need you to sign the attached NOA . Please return to ~l 2) l(b)(6) kcc'd). lwill then send you the latest package under separate cover. VA-18-0298-I-000973 Pag e 1659 of 2i'% of 1380 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) l(who is the government contracting officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask l(b)(6) i(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-I-000974 Page 1660 of 2i1/a of 1380 Document ID: 0.7.1705.1768534 Blackburn , Scott R. To: ,...;.;..-'---.....i,;; a:..; frenchangel59. com> ; p.....,.;'-'-- ....l>==; mail .coml(b)(6) l@gmail.com> j(b)(6) ..,.._....'-'-- __ __. ....... ....... ""'I· .com>; Bruce Moskowitz ,....._ ___ @gmail .com __. ~mac.com> ; Windom, John H. ; DJS ,....._ Bee: Subject: Date: Attachments: ____ ~ '-r--------.-----" Cc: 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 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) 6 We will need you to sign the attached NOA. Please return to .... l(b_)(_ )__ _,l(cc'd). 2) l(b)(6) 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 expertise will be most valuable. l(b)(6) l(who is the government contractin officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask (b)(6) (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-I-000975 Page 1670 of 2i1/s of 1380 Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-000976 Page 167 1 of 2~ 7~of 1380 Document ID: 0.7.1705.499460 Blackburn, Scott R. I (b>(5> frenchangel59.com> : To: @gma il.com> l(b)(6) @gmail.com (b)(6) gmail.com l(b)(6) (b)(6) mail.com>; Bruce Moskowitz ._____ ....., (b)(6) mac.com> Cc: ; DJS Bee: Subject: VA EHR NOA Tue Mar 13 2018 10:31 :27 EDT Date: NDA_blank EHRM for signature.pdf Attachments: 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) (b_)(G _)_~I We will need you to sign the attached NOA. Please return to ~l (cc'd). 2) l(b)(6) 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 ou to the contract and help focus you on the parts where your expertise will be most valuable . (b)(6) who is the government contractin officer) and John Windom (who is our EHR leader) will lead this from our side. I will ask (b)(6) (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-I-000977 Page 1675 of 2i117 of 1380 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000978 Page 1676 of 2~ 7~of 1380 Document ID: 0.7.1705.1768443 Blackburn, Scott R. Stan Huff l(b)(6) To: @imail.org> Windom, John H. ; (b)(6) ; Foster, Michele (SES) ; l(b)(6) l(b)(6) l/o=va/ou=exchange administrative group ~~-~ (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> 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(b)(6) @imail.org] Sent: Monday, March 12, 2018 9:25 PM To: Blackburn, Scott R. 6l_____ (b-)(6 __ )___ __,,IFoster , Michele (SES) ; .... l(b_)(_ Cc: Windom, John H.; 1.-Subject: [EXTERNAL] RE: VA EHR __. 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 current ly 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 To: Stan Huff l(b)(6) @imai l.org> Cc: Windom , John H.:l(b)(6) Michele (SES) ; ._l (b_)(_6)____________ Subject: RE: VA EHR l@va.gov>; Foster , ___.@va.gov > Stan: VA-18-0298-I-000979 Page 1680 of 2i'% of 1380 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) We will need you to sign the attached NOA. Please return to "'-l (b-'-' )(""""'6 )__ 2) l(b)(6) _,~cc'd) . 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 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 you. I will ask i(b)(6) (cc'd) here to help set up a time. I Thanks again! Scott From: Stan Huff i(b)(6) @imail.org] 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. VA-18-0298-I-000980 Page 168 1 of 2i1iof 1380 Thanks so much, Scott Scott Blackburn Acting C IO & Executive -in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-000981 Page 1682 of 2~ 8~of 1380 Document ID: 0.7.1705.498442 Blackburn , Scott R. imail.org> Stan Huff b 6 To: Windom , John H. Cc: ; l(b)(6) l; l(b)(6) To: Stan Huff [(b)(6) Cc: Windom, John H.; ._l (b_)(_6)_________ __.@va.gov>; Foster , VA-18-0298-I-000982 Page 1683 of 2i1~of 1380 Michele (SES) ; ..... l(b_)(_6)____________ Subject: RE: VA EHR ___.@va.gov> Stan: Thank you for agreeing to be an extra set of outside eyes as we at VA fina lize our EHR contract. We appreciate your vast exper ience 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. 1) (b_)(6 _) _ ___.l(cc'd). We wi ll need you to sign the attached NOA. Please return to ~l 2) l(b)(6) !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 valuab le. (b)(6) 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)(6) l(cc'd) here to help set up a time. Thanks again! Scott @imail.org] From: Stan Huff l(b)(6) 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-I-000983 Page 1684 of 2i1~of 1380 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-I-000984 Page 1685 of 2~ 8~of 1380 Document ID: 0.7.1705.1216001 From: Stan Huff !(b)(6) @imail.org> To: Blackburn, Scott R. Windom , John H. ; (b)(6) ; Foster, Michele (SES) .._b_... )(6_,_ )__ _. ;!( Bee: Subject: [EXTERNAL] RE: VA EHR Date: Mon Mar 12 2018 21:25:23 EDT Attachments: I 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 current ly avai lable 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 To: Stan Huff l(b)(6) @imail.org> Cc: Windom, John H. ; !(b)(6) ,!-!=============== Michele (SES) ; ._! (b_)(_6)____________ Subject: RE: VA EHR ra)va.gov>; Foster , =-=-=.:..:;L:....:..., _. @va.gov> Stan: Thank you for agreei ng 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_)(6_) _ We will need you to sign the attached NOA. Please return to l._ 2) l(b)(6) _.I(cc'd) . Iwill 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 !will lead this from our side and has told me is available expertise will be most valuable. l(b)(6) VA-18-0298-I-000985 Page 1686 of 2i1~of 1380 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)(6) l(cc 'd) here to help set up a time. Thanks again! Scott @imail.org] From: Stan Huff!(b)(6) 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-I-000986 Page 1687 of 2i1iof 1380 Document ID: 0.7.1705.498168 @imail.org> From: Stan Huff -l(b-)(-6)-~ To: Blackburn, Scott R. Cc: Windom , John H. ; (b)(6) ; l(b)(6) Cc: Windom, John H. ,.... :IL.:... (b..:..: )(-'6)__________ Miche le (SES) ; l(b)(6) 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 con tract. 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 volunteer ing your time, we want to make this as easy as possible for you. Here are 3 next steps. 1) l(b_)(6 _l _ ____.l (cc'd). We will need you to sign the attached NOA. Please return to ..... VA-18-0298-I-000987 Page 1689 of 2i1~of 1380 2) l(b)(6) 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 ou to the contract and help focus you on the parts where your expertise will be most valuable. (b)(6) 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)(6) (cc'd) here to help set up a time . I Thanks again! Scott From: Stan Huff l(b)(6) ~ima il.org) 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 Shulk in I wanted to see if we could enlis t 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-I-000988 Page 1690 of 2i1iof 1380 Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000989 Page 169 1 of 2~ 8~of 1380 Document ID: 0.7.1705.498142 Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 21:15:06 EDT Attachments: NDA_blank EHRM for signature.pdf 1> 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 . From: David Shulkin l(b)(6) @gmail.com] 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: IPEJ@frenchangel59.com> Date: March 12, 2018 at 2:50 :52 PM EDT To: David Shulkin( b)(6) mail.com> @gmail.com" (b)(6) mail.com>, ,....l (b_)(6 _l __ Cc: !{b)(6) com> , Bruce Moskowitz (b)(6) mac .com> Subject: RE: Contact review 5 __. l@gmail.com" .... l(b_)(_ 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. -----Original Message----- VA-18-0298-I-000990 Page 1692 of 2i1i of 1380 From: Bruce Moskowitz l(b)(6) @mac .com] Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin !{bl(6l @gmail.com> Cc: I ~frenchangel59 .com>; l(b)(6) @gmail.com ; ~l (b_)(6 _l__ Subject:R.i: Contact review ~l@gmail.com 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_)(6 _)__ ~~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-I-000991 Page 1693 of 2i1~of 1380 Thanks so much David Sent from my iPhone On Mar 11, 20 18, at 12:42 PM, Bruce Moskowitz l._ (b--)(__ 6)_______ 1@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_)(6_) __ ~ @gmail.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone On Mar 11, 20 18, at 11 :02 AM, Bruce Moskowitz l(b ..... _)(_6 )_______ @mac.com> wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiunta in Jonathan ManisCIO- suttrr VA-18-0298-I-000992 Page 1694 of 2i1~of 1380 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-I-000993 Page 1695 of 2~ 9~of 1380 Document ID: 0.7.1705.498115 Blackburn , Scott R. Stan Huff !(b)(6) @imail.org> To: Windom , John H. Cc: ; l(b)(6) administrative group (fydibohf23spdlt)/cn=recipients/cn=045f8eff 429f45888be 795fbaa 1d 9ef2 ~(b)(6) Foster, Michele (SES) ; l(b)(6) 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 Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000995 Page 1700 of 2i1~of 1380 Document ID: 0.7.1705.1215992 Blackburn , Scott R. Stan Huff!(b)(6) @imail.org> To: Windom , John H. ; (b)(6) ; Foster, Michele (SES) ; j(b)(6) l(b)(6) Bee: Subject: RE: VA EHR Date: Mon Mar 12 2018 21:08:16 EDT Attachments: NDA_blank EHRM for signature.pdf , I 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. 1) We will need you to sign the attached NOA. Please return to ._l (b_)(6 _l _ ___,l (cc'd). 2) l(b)(6) 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 ou to the contract and help focus you on the parts where your expertise will be most valuable . (b)(6) 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)(6) l (cc'd) here to help set up a time. Thanks again! Scott From: Stan Huff l(b)(6) lcv,imail.org] Sent: Monday, March 12, 2018 4:34 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Re: VA EHR VA-18-0298-I-000996 Page 1704 of 2i1iof 1380 Yes, I wou ld be glad to help . What is the next step? Sta n Sent fr om Stan Huff's iPho ne On Ma r 12, 20 18, at 6:54 AM, Blackburn, Scott R. wrote: Stan, I hope t his finds you we ll. 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 ma ke sure we get a few extra set of eyes on it to make sure we are do ing right by Ve terans, the cou ntry and taxpayers . Would you have the time/abil ity to conduct a quick high level rev iew and prov ide input in the next week or so? You we re refer red to us by Dr. Bruce Moskow itz. T hanks so much, Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-000997 Page 1705 of 2~ 9~of 1380 Document ID: 0.7.1705.497775 From: Stan Huff .-l (b-)(-6)----,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-I-000998 Page 1709 of 2i1iof 1380 Document ID: 0.7.1705.497648 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: 18 What do you think of having Ike/Bruce/Marc sign NDA's as well? Seems they are willing to "work around the clock to finish this". From: David Shulkin l(b)(6) l@gmail.com] 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: .com> From: l~frenchangel59 Date: March 12, 2018 at 2:50 :52 PM EDT To : David Shulkin (b)(6) mail.com > Cc: l(b)(6) @gmail.com" (b)(6) gmail.com> , I._ (b_)(6 _)__ com> , Bruce Moskowitz l(b)(6) l@mac.com> Subject: RE: Contact review ~@gmail.com" ._l (b_)(_ G)__ ___. @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 . -----Original Message ----From: Bruce Moskowitz ~l (b-)(-6)-------~ @mac.com] Sent: Monday, March 12, 2018 2:03 PM To: David Shulkinl(b)(6) @qmail.com> Cc: l~frenchangel59 .com>; !(b)(6) l@gmail.com; l._ (b_)(6 _)__ _,@gmail.com VA-18-0298-I-000999 Page 1710 of 2i1iof 1380 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 Psych iatry 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_)(_ 6)__ ~@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-I-001000 Page 171 1 of ~ibiof 1380 David Sent from my iPhone On Mar 11, 2018, at 12:42 PM , Bruce Moskowitz l._ (b_)(_ 6)_____ _.@mac.com > wrote : He is a cardiologist and administration Sent from my iPhone 6)__ On Mar 11, 2018, at 12:31 PM, David Shulkin ._l (b_)(_ _.@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_)(_6)_____ ~ @mac.com > wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- inte rmiuntain 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-I-001001 Page 1712 of ~ib~of 1380 Moskowitz MD. Page 1713 ?f #36? of 1380 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 well? Seems they are willing to "work around the clock to finish this". From: David Shulkin l(b)(G) @gmail.com] 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: .com> From: IP~frenchangel59 Date: March 12, 2018 at 2:50 :52 PM EDT To: David Shulkin (b)(6) mail.com> Cc: l(b)(6) @gmail.com" (b)(6) mail.com>, ..... l(b_)(6_l __ com> , Bruce Moskowitz (b)(6) mac.com> Subject: RE: Contact review 6l__ __, @gmail.com" I.... (b_)(_ _. 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 . -----Original Message----(b-)(-6)---------. l@mac.eom] From: Bruce Moskowitz .-l Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin l(b)(6) @ mail.com> Cc: l~frenchangel59 .com>; (b)(6) gmail.com; l,_ (b_)(6 _)__ Subjen;: Contact review _.@gmail.com VA-18-0298-I-001003 Page 1714 of ~ib~of 1380 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_,_,_ )( 6) ......__ _.@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-I-001004 Page 1715 of ~ibiof 1380 David Sent from my iPhone On Mar 11, 2018, at 12:42 PM, Bruce Moskowitz .... l(b_)(_6l_____ __. @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_)(_ 6)__ ~@gmail.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_)(_6)_____ ~ @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-I-001005 Page 171 6 of ~ib~of 1380 Document ID: 0.7.1705.497644 Blackburn , Scott R. To: Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 16:22 :15 EDT Attachments: 1> 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. From: David Shulkin l(b)(6) @gmail.com] 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 me ssage: .com> From: IP~frenchangel59 Date: March 12, 2018 at 2:50:52 PM EDT (b..:..: )(,.,..:6 )__ ~~ m .:...:.= aic:..:, l.c,om> To: David Shulkin i.:... 6)__ Cc:l(b)(6) @gmail.co~m !.!.. '....i.: ' (~ b)..:... (6.:.. ) -~ = m !.!.!!:; ail.com>, ._l (b_)(_ com>, Bruce Moskowitz (b)(6) mac.com> Subject: RE : Contact review ____. @gmail.com" ._l (b_)(6 _)__ ___,@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. -----Original Message----From: Bruce Moskowitz .-l (b-)(-6)---------.l @mac.eom] Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin l(b)(6) @gmail.com> Cc: 1pr x0 > 1@frenchangel59.com>; l(b)(6) @gmail.com ; l._ (b_)(G _)__ ..... @gmail.com VA-18-0298-I-001006 Page 171 8 of ~ibiof 1380 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 Psych iatry 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_)(6 _)__ __. @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-I-001007 Page 171 9 of ~ib~of 1380 David Sent from my iPhone 1(b_)(_6 l_____ On Mar 11, 2018, at 12:42 PM, Bruce Moskowitz .... ~ @mac.com > wrote : He is a cardiologist and administration Sent from my iPhone l(b_)(_6)__ On Mar 11, 2018, at 12:31 PM, David Shulkin .... _,~gma il.com> wrote: Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone (b_)(_6 )_____ On Mar 11, 2018, at 11:02 AM, Bruce Moskowitz 1.... ~ @mac.com > wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain Jonathan ManisC IO- suttrr Andrew Karson MD.- partners Leslie Cooper M.D. Clifford Ko M.D.- amer ican college surgeons Sent from my iPad Bruce VA-18-0298-I-001008 Page 1720 of ~ibiof 1380 Moskowitz MD. Page 1721 ?f @353 of 1380 Document ID: 0.7.1705.497639 (b-)(-6)--~ kg)gmail.com> From: David Shulkin ~l To: Blackburn, Scott R. Cc: Bee: Subject: [EXTERNAL] Fwd: Contact review Date: Mon Mar 12 2018 16:17:39 EDT Attachments: Can we get them the nda as well? Sent from my iPhone Begin forwarded message: From: 1Ff<6il@frenchangel59.com> Date: March 12, 2018 at 2:50:52 PM EDT To: David Shulkin l(b)(G) @gmail.com> Cc: l(b)(G) @gmail.com" !(b)(6) l@gmail.com>, ._l (b_)(6_)__ com> , Bruce Moskowitz l(b)(G) @mac.com> Subject: RE: Contact review 5 >__ ......, l@gmail.com" ..... l(b_)(_ ~l @gmai l. 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 . -----Original Message----(b-)(-6)----------, @mac.eom] From: Bruce Moskowitz .-l Sent: Monday, March 12, 2018 2:03 PM To: David Shulkin l(b)(G) @gmail.com> Cc: IP~frenchangel59 .com>;l(b)(6) @gmail.com; ..... l(b_)(_6>__ Subje~e: Contact review ___, @gmail.com 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. VA-18-0298-I-001010 Page 1722 of ~i~iof 1380 Sent from my iPad Bruce Moskowitz M.D. 5 On Mar 12, 2018, at 1 :53 PM, David Shulkin ..... l(b_)(_l____ @gmail.com> wrote: Bruce- we got 4 of 6 on board so far plus one additional Manis Reel Karson Ko A lso 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-I-001011 Page 1723 of ~i~~ of 1380 Thanks so much David Sent from my iPhone On Mar 11, 2018, at 12:42 PM, Bruce Moskowitz j-(b_)(_6)______ 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 (b_)(_ 6)__ _,@gmail.com> wrote: Great list VA-18-0298-I-001012 Page 1724 of ~i~~ of 1380 Is leslie cooper from mayo- i could not find him or her Sent from my iPhone 6l_____ (b_)(_ 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-I-001013 Page 1725 of ~i~~ of 1380 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-I-001014 Page 1726 of ~i~iof 1380 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 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-I-001015 Page 172 7 of ~i~~ of 1380 Document ID: 0.7.1705.496786 Blackburn, Scott R. 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 ; howev er 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-I-001016 Page 1728 of ~i~iof 1380 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 ; 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 CIO & Executive-in-Charge, Office of Infor mation & Technology Department of Veterans Affairs VA-18-0298-I-001017 Page 1729 of ~i~~ of 1380 Document ID: 0.7.1705.496414 Blackburn , Scott R. David Shulkin !(b)(6) To: Cc: Bee: Subject: RE: [EXTERNAL] Fwd: Contact review Date: Sun Mar 11 2018 12:36:59 EDT Attachments: 1> 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(b)(6) @gmail.com] Sent: Sunday , March 11, 201812:32 PM To: Blackburn, Scott R. Subject: [EXTERNAL] Fwd: Contact review Scott lets discuss tommorow Sent from my iPhone Begin forwarded message: From: David Shulkin !(b)(6) @gmail. com> Date: March 11, 2018 at 12:31 :22 PM EDT To : Bruce Moskowitz u..: 6 Cc: 1pr X) 1@frenchangel59.com>, (b)(G) gmail.com, .... l(b_)(_6)__ Subject: Re: Contact review __,@gmail.com Great list Is leslie cooper from mayo- i could not find him or her Sent from my iPhone (b-')('""'6 )______ On Mar 11, 2018, at 11 :02 AM, Bruce Moskowitz "'"! @mac.com> wrote : VA-18-0298-I-001018 Page 173 0 of ~i~iof 1380 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-I-001019 Page 173 1 of t~rn of 1380 Document ID: 0.7.1705.386382 From: David Shulkin l(b)(6) @gmail.com> To: Blackburn, Scott R. Scott lets discuss tommorow Sent from my iPhone Begin forwarded message: From : David Shulkin i(b)(6) @gmail.com > Date: March 11, 2018 at 12:31 :22 PM EDT To: Bruce Moskowitz u;: (b:-'-l l(.:..6 l~ _____ ......., .,.mac.com> 6l ___ Cc: l~ frenchangel59.com> (b)(6) gmail.com, ,....l (b_l(_ Subject: Re: Contact review ra>,gma il.com 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_)(_6)_____ ~l @mac.com> wrote : These are the individuals to review the contract ; Stephanie Reel CIO- hopkins Stan Huff CIO- intermiuntain VA-18-0298-I-001020 Page 1732 of ~i1iof 1380 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-I-001021 Page 1733 of t~2~of 1380 Document ID: 0.7.1705.1509396 Colli, Jacqueline (b)(6) ; Blackburn , Scott R. ; l(b)(6) (b)(6) /o=va/ou=va martinsburg/cn=recipients/cn=vacophamk> (b)(6) ; Rinchack, Diane ; Llamas , Jose ; Turner , Tanya T. Bee: RE: SecVA Subject: Fri Mar 09 2018 20:02 :47 EST Date: Attachments: Just confirming the SecVA flights and itinerary shou ld go back to the original plans. Thank you. JV . From: .... l(b_)(_ 6)__ ____, Sent: Friday , March 09, 2018 1:10:18 PM To : Blackburn, Scott R.: l(b)(6) I Cc: Colli, Jacqueline ;l(b)(6) Rinchack, Diane ; Llamas , Jose; Turner , Tanya T. Subj ect: RE: SecVA I 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: l(b)(6) Cc: Colli, Jacqueline ;~l (b_)(_6)__________ Tanya T. Subject: RE: SecVA I ~1Rinchack , Diane; Llamas, Jose; Turner, VA-18-0298-I-001022 Page 1734 of ~i1~ of 1380 Awesome! Thanks so much. (b_)(_6)____ ~ From: ~l Sent: Friday, March 09, 2018 2:50 PM To: Blackburn, Scott R. Cc: Colli, Jacque line;~l (b-)(-6-)---------~I Tanya T. Subject: RE: SecVA Rinchack , Diane; Llamas, Jose; Turner, Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To: l(b)(6) Cc: Colli, Jacqueline ;~l (b-)(-6)----------~ Subject: RE: SecVA I I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good.com) I From: l(b)(6) Sent: Friday, March 09, 2018 2:18:28 PM To : Blackburn, Scott R. Cc: Colli, Jacque line;~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 departing early afternoon on Monday or early on Tuesday . Please confirm if you are available to trave l with him. Thanks . VA-18-0298-I-001023 Page 1735 of ~i1~ of 1380 Document ID: 0.7.1705.1509026 From: Llamas, Jose (b)(6) ; Blackburn , Scott R. ; l(b)(6) (b)(6) Colli, Jacqueline ; l,__ (b_)(_6)_____ ; Rinchack, Diane ; Turner, Tanya T. Bee: Re: SecVA Subject: Fri Mar 09 20 18 16:17 :23 EST Date: Attachments: Roger that on our end. From: l(b)(6) @va.gov> Date: Friday, March 9, 2018 at 4:10 PM @va.J§v> To: "Blackburn , Scott R." .l(b)(6l Cc: Jacque line Colli , l(b)(6) va. gov>, "Rinchack , Diane" , vacoll amaj , Tanya Turner Subject: RE: SecVA 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 : !(b)(6) Cc: Colli, Jacqueline ;l(b)(6) ~-----------~ Tanya T. I IRinchack , Diane; Llamas , Jose ; Turne r, Subject: RE: SecVA Awesome! Thanks so much . (b_)(6 _)___ From: ,...._l ___. VA-18-0298-I-001024 Page 1736 of ~i1iof 1380 Sent: Friday , March 09, 2018 2:50 PM To: Blackburn, Scott R r-'-. -------------. Cc: Colli, Jacqueline ;l(b)(6) Tanya T. Subject: RE: SecVA IRinchack , Diane; Llamas, Jose; Turner, Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening . He said you can leave after the 11am meeting . I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To: l(b)(6) Cc: Colli , Jacqueline ; ,-l (b-)(-6)------------, I Subject: RE: SecVA I'll be there . I'll plan to mimic his schedule. Sent with Good (www.good .com) I From: l(b)(6) Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli , Jacqueline ; ~l (b-)(-6)----------~ Subject: SecVA 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-I-001025 Page 1737 of ~i1~of 1380 Document ID: 0.7.1705.493958 From: l(b)(G) ! To: Blackburn, Scott R. ; l(b)(G) (b)(G) ; l(b)(G) ; Llamas , Jose ; Turner , Tanya T. Bee: Subject: RE: SecVA Date: Fri Mar 09 2018 16:10:18 EST Attachments: I 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: l(b)(G) Cc: Colli, Jacqueline ; .... l(b_)(_6)__________ Tanya T. Subject: RE: SecVA I ___.I Rinchack , Diane; Llamas, Jose; Turner, Awesome! Thanks so much . I From: l(b)(G) Sent: Friday, March 09, 2018 2:50 PM To: Blackburn, Scott R~·-----------~ Cc: Colli, Jacqueline ; l(b)(G) Tanya T. IRinchack , Diane; Llamas, Jose; Turner, VA-18-0298-I-001026 Page 1738 of ~i1iof 1380 Subject: RE: SecVA Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To: l(b )(6) Cc: Colli, Jacqueline ; .-l (b-)(-6)-----------.. Subject: RE: SecVA I I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good .com) I From: l(b)(6) Sent: Friday, March 09, 2018 2: 18:28 PM To: Blackburn , Scott R. (b-)(-6)----------~ Cc: Colli, Jacqueline ;~l 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 departing early afternoon on Monday or ear ly on Tuesday . Please confirm if you are available to travel with him. Thanks . VA-18-0298-I-001027 Page 1739 of ~i1~ of 1380 Document ID: 0.7.1705.386068 !(b)(6) ! Blackburn, Scott R. (DISABLED ACCT) To: ;l(b)(G) (b)(G) /o=va/ou=va martinsburg/cn=recipients/cn=vacophamk> Colli, Jacqueline ; l~ (b_)(_G)_____ ~ ; Rinchack, Diane ; Llamas, Jose ; Turner , Tanya T. Bee: Subject: RE: SecVA Date: Fri Mar 09 2018 16:10:18 EST Attachments: 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: l(b)(G) I Cc: Colli, Jacqueline ;,-l (b-)(-6)-------------,1 Tanya T. Subject: RE: SecVA Rinchack, Diane; Llamas, Jose; Turner, Awesome! Thanks so much. From: l(b)(G) I Sent: Friday, March 09, 2018 2:50 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline ; .-l (b-)(_6_ ) -------------.I Tanya T. Subject: RE: SecVA Rinchack, Diane; Llamas, Jose ; Turner, Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flights. Thank you! VA-18-0298-I-001028 Page 17 40 of ~i1iof 1380 From: Blackburn, Scott R. Sent: Friday, March 09 , 2018 2:19 PM I To: l(b)/6) Cc: Colli, Jacqueline J... (b_)(_6)__________ Subject: RE: SecVA _. I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good .com) I From: l(b)(6) Sent: Friday, March 09 , 2018 2:18:28 PM To : Blackburn, Scott R. (b-)(-6)------------. Cc: Colli , Jacqueline ;.-l Subject: SecVA 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 avai lable to travel with him . Thanks. VA-18-0298-I-001029 Page 1741 of ~i1iof 1380 Document ID: 0.7.1705.493957 From: Blackburn, Scott R. (b)(6) Cc: Colli, Jacqueline ; ._l (b_)(_6_ ) ---,-~ ; l(b)(6) !; Rinchack, Diane ; Llamas , Jose ; Turner, Tanya T. Bee: RE: SecVA Subject: Date: Fri Mar 09 2018 16:09 :21 EST Attachments: Awesome! Thanks so much . From:"--l (b-'--' )(--'6)____ _. Sent: Friday , March 09, 2018 2:50 PM To: Blackburn, Scott R. Cc: Colli , Jacqueline ;,....l (b-)(-6)-------------.1 Tanya T. Subject: RE: SecVA Rinchack , Diane; Llamas, Jose; Turner, Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening . He said you can leave after the 11am meeting . I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2: 19 PM 1.-----------. To: l(b)(6) Cc: Colli, Jacqueline ; ._l (b_)(_6)__________ Subject: RE: SecVA _. I'll be there. I'll plan to mimic his schedule. VA-18-0298-I-001030 Page 17 42 of ~i\iof 1380 Sent with Good (www.good .com) From: ~l (b_)(_6)____ ~ Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. (b-)(-6)------------. Cc: Colli, Jacqueline ; .-l Subject: SecVA 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 depart ing early afternoon on Monday or early on Tuesday . Please confirm if you are available to travel with him. Thanks. VA-18-0298-I-001031 Page 17 43 of ~i\~of 1380 Document ID: 0.7.1705.1508566 From: !(b)(G) ! To: Blackburn, Scott R. Cc: Colli, Jacqueline ; l~ (b_)(G _)__ ~ ; l(b)(G) ~/o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2>; Rinchack, Diane ; Llamas , Jose ; Turner, Tanya T. Bee: RE: SecVA Subject: Date: Fri Mar 09 2018 14:49 :32 EST Attachments: Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening. He said you can leave after the 11am meeting. I've added our travel team to provide you details of flight s. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2: 19 PM To: l(b)(G) Cc: Colli, Jacqueline ; .... l(b_)(_G )__________ Subject: RE: SecVA I ~ I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good.com) I From: l(b)(G) Sent: Friday , March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline ; .-l (b-)(-6)-------------. Subject: SecVA VA-18-0298-I-001032 Page 17 44 of ~i\~of 1380 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 depart ing early afternoon on Monday or early on Tuesday. Please confirm if you are available to travel with him . Thanks . VA-18-0298-I-001033 Page 17 45 of tM~of 1380 Document ID: 0.7.1705.493562 From: l(b)(6) ! To: Blackburn, Scott R. Cc: Colli, Jacqueline ; l(b)(Gl I; l(b)(6) ; Rinchack, Diane ; Llamas , Jose ; Turner , Tanya T. Bee: Subject: RE: SecVA Date: Fri Mar 09 2018 14:49:32 EST Attachments: I Scott - meeting is confirmed for 11am on Tuesday. Boss will fly out on Tuesday in the AM. He has a speech and dinner that evening . He said you can leave after the 11am meeting . I've added our travel team to provide you details of flights. Thank you! From: Blackburn, Scott R. Sent: Friday, March 09, 2018 2:19 PM To :l(b)(6) I Cc: Colli, Jacqueline ; .... l(b"""' )("'""'6 )__________ Subject: RE: SecVA _. I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good .com) VA-18-0298-I-001034 Page 17 46 of ~i\iof 1380 I From:l(b)(6) Sent: Friday, March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline ;,-l (b-)(-6)-----------.. Subject: SecVA 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 trave l with him. Thanks. VA-18-0298-I-001035 Page 1747 of ~i\~of 1380 Document ID: 0.7.1705.1508416 !(b)(6) ! To: Blackburn, Scott R. Cc: Colli, Jacqueline ;~l (b_)(_ 6)__ ~ ; l(b)(6) l 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(b)(6) I Cc: Colli , Jacqueline ; ~l (b-)(-6)----------~ Subject: RE: SecVA I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good .com) 6)____ From: ~l (b_)(_ _. Sent: Friday , March 09, 2018 2:18:28 PM To: Blackburn, Scott R. Cc: Colli, Jacqueline ;~l (b-)(-6)---------~ Subject: SecVA 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 depart ing early afternoon on Monday or early on Tuesday . Please confirm if you are available to travel with him . Thanks . VA-18-0298-I-001036 Page 17 48 of ~i\iof 1380 Document ID: 0.7.1705.493490 l(b)(6) ! To: Blackburn, Scott R. Cc: Colli, Jacqueline : !/bl/6l !; l(b)(6) (b)(G) /o=va/ou=va To: martinsburg/cn=recipients/cn=vacophamk> Cc: Colli, Jacqueline ; l= (b""' )(..;;.. 6).____ _. ; l(b)(G) l Bee: RE: SecVA Subject: Fri Mar 09 2018 14:19:27 EST Date: Attachments: I'll be there. I'll plan to mimic his schedule. Sent with Good (www.good.com) (b_)(G _)___ ~ From: ~l Sent: Friday , March 09 , 2018 2:18:28 PM To: Blackburn, Scott R. (b-)(6 _)_________ Cc: Colli, Jacqueline ;.-l _, Subject: SecVA 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 ear ly on Tuesday . Please confirm if you are available to travel with him . Thanks . VA-18-0298-I-001038 Page 175 1 of ~i\iof 1380 Document ID: 0.7.1705.493331 Blackburn, Scott R. (b)(6) To: ; l(b)(6l administrative group (fydibohf23s dlt /cn=reci ients/cn=e04c02929f184bffbb82bbd27f5b c6ad (b)(6) To: Blackburn, Scott R. Cc: Colli, Jacqueline : l~ (b~)(~ G)__ ~ ; l(b)(G) Bee: SecVA Subject: Fri Mar 09 2018 14:18:28 EST Date: Attachments: I 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-I-001040 Page 1753 of ~i\iof 1380 Document ID: 0.7.1705.493328 From: !(b)(G) ! To: Blackburn, Scott R. Cc: Colli, Jacqueline ; (b)(G) To: O'Rourke, Peter M. ; Bruce Moskowitz (b)(G) mac .com> Cc: Sandoval, Camilo J. ; Marc Sherman (b)(G) @gmail.com>; IPEJ@frenchangel59.com> Bee: RE: [EXTERNAL ] Re: Apple 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 (b_J(_l________ Please use the following: l._ __. Thanks, Meredith 202-461-5775 -----Original Message ----From: O'Rourke , Peter M. Sent: Thursday , March 08, 2018 7:23 AM To : Bruce Moskowitz Cc: Sandoval , Cam ilo J.; Marc Sherman; IP; Bumpus , Meredith Subject: RE: [EXTERNAL] Re: Apple vs Gerner Understood . I'll notify you today of a time and conference call in number . Pete -----Original Message----~---------~ From: Bruce Moskowitz l(b)(G) 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 Cerner @mac.com] 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. > > I'll have my scheduler set something up for Friday if that works for you all. wrote: > VA-18-0298-I-001042 Page 1755 of ~i\~of 1380 > Pete > > -----Original Message----> From: Bruce Moskowitz ~ !(b -}{-6}-------~ @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 > 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)(6) @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 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-I-001043 Page 1756 of ~i\~of 1380 >>> 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 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)(6) >>> Executiv~e_A_s_s-is-ta_n_t_ : -M~s. l(b)(S) Appointments and Scheduling l@va.go-~v..,.1 (-bl... (6-l --------.l @va .gov> Office: (202) 461-6618 >>> j(b)(6) >>> >>> >>> >>> >>> 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 1.-----------. >>> Mobile: l(b)(6) >>> Executive Assistant: Ms. ~ (6) I-Appointments and Scheduling @va.g ovj(b)(6) l@va.gov> Office: (202) 461-6618 >>> i(b)(6) I- VA-18-0298-I-001044 Page 1757 of ~i\iof 1380 >>> >>> >>> >>> >>> >> Questions _final.docx> VA-18-0298-I-001045 Page 1758 of t~l~of 1380 Document ID: 0.7.1705.384327 Sandoval, Camilo J. To: Bruce Moskowitz l(b)(6) @mac .com>;O'Rourke, Peter M. Marc Sherman (b)(6) gmail.com> ; IP Cc: l(b)(6) l@frencha ngel 59. com> Bee: RE: [EXTERNAL] Re: Apple vs Cerner Subject: Thu Mar 08 2018 07:34:46 EST Date: Attachments: Pete , I'm available anytime for this on Friday . Thanks Camilo From: Bruce Moskowitz Sent: Thursday, March 08, 2018 4:15:56 AM To: O'Rourke , Peter M. Cc: Sandoval, Camilo J.; Marc Sherman; IP Subject: Re: [EXTERNAL] Re: Apple vs Cerner Thank you I have noon or after 4 or before 7 am. It will 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. > > I'll have my schedu ler set something up for Friday if that works for you all. > > Pete wrote: > > -----Original Message----> From: Bruce Moskowitz ,....l (b-)(-6)---------. @mac.eom] > 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 conven ient 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 VA-18-0298-I-001046 Page 1759 of ~i\iof 1380 > 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)(6) @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-I-001047 Page 1760 of ~i\~of 1380 >>> 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 >>> Mobile: _l (b~ )(~6 )___ ~ >>> Executive Assistant: Ms. ,....l (b-)(-6)--------.I -Appoin tments and Scheduling >>1(b)(6) l@va.gov !(b}/6} 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) 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)(6) >>> Executive Assistant: Ms. l(b)(6) Appointments and Scheduling >>~(b)(6) l@va.gov i(b)(6) l@va.gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> >> Questions _final.docx> I .---------. I- VA-18-0298-I-001048 Page 1761 of ~i\iof 1380 Document ID: 0.7.1705.384312 From: O'Rourke, Peter M. To: Bruce Moskowitz l(b)(6) l@mac.com> Sandoval, Camilo J. ; Marc Sherman frenchangel59.com>; Bumpus, (b)(6) gmail.com>; l~ Meredith 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 Moskowitz ~l (b-)(-6)-------~ 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 l@mac.com] Thank you I have noon or after 4 or before 7 am. It will probably ju st 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(b)(6) 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 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: >> VA-18-0298-I-001049 Page 1762 of ~i\iof 1380 >> 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)(6 ) @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-I-001050 Page 1763 of ~iYc of 1380 >>> 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: l(b)(6) >>> Executive Assistant: Ms. l(b)(6) Appointments and Scheduling >>>!(b)(6) l@va .govi(b)(6) @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:l(b)(6) >>> Executive Assistant: Ms.lM_(6) I- A , oointments and Scheduling >>> i(b)(6) 1@va.gov !(b)(6) J@va.gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> >> Questions _final.docx> I .--------. I- I ,,,....,..,,.,,.,....-------. VA-18-0298-I-001051 Page 1764 of ~i~ of 1380 Document ID: 0.7.1705.384322 Bruce Moskowitz From: l(b)(6l @mac.com> O'Rourke, Peter M. Sandoval, Camilo J. ; Marc Sherman l(b)(6) @gmail.com>; 1pr XO) l@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(b)(6) @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-)(-6)-------~ @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-I-001052 Page 1765 of ~i~ of 1380 >> 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 (b"'"' )(._6 ).__ ___ _, >> > Mobile: ... VA-18-0298-I-001053 Page 1766 of ~i~ of 1380 >>> Executive Assistant: Ms. l(b)(S) I-Appointments and Scheduling >>~(b)(6) @va.go'-v--,.j (-b)-(6-) -----"'--....:... @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 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 >>> Mobile:(b)(6) _ s_s-is-t-an_t_: -M~s. l(b)(6) Appointments and Scheduling >>> Executiv._e_A >>>!(b)(6) l@va.go._ v_<~l (b-)(-6)-----~l@va.gov> Office: (202) 461-6618 >>> >>> >>> >>> >>> >> Questions _final.docx> I- VA-18-0298-I-001054 Page 1767 of ~iYJi of 1380 Document ID: 0.7.1705.384306 O'Rourke, Peter M. To: Bruce Moskowitz l(b)(6) @mac .com> Sandoval, Camilo J. ; Marc Sherman (b)(6) gmail.com>; 1Ft::J@frenchangel59.com> Bee: Subject: RE: [EXTERNAL] Re: Apple vs Gerner Date: Thu Mar 08 2018 07:14:42 EST Attachments: I'll have my scheduler set something up for Friday if that works for you all. Pete -----Original Message----From: Bruce Moskowitz.-l (b-)(-6)--------. 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 @mac.eom] 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)(6) @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-I-001055 Page 1768 of ~iYs of 1380 > 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, >> 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 : l(b)(6) >> Executive Assistant: Ms. l(b)(6) Appointments and Scheduling >~(b)(6) @va .g01(b)(6) 1@va.gov> Office: (202) 461-6618 >> >> >> >> >> From : Windom, John H. ------------- I ~------~ I- VA-18-0298-I-001056 Page 1769 of ~i~ of 1380 >> 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: l(b)(6l I >> Executive Assistant: Ms. l(b)(6) I- Appointments and Scheduling >*b )(6) @va.go~v-;=j (b=)(== =6 )======'------'-, @va.gov> Office: (202) 461-6618 >> >> >> >> >> > Questions _final.docx> VA-18-0298-I-001057 Page 177 0 of ~i~ of 1380 Document ID: 0.7.1705.384303 Bruce Moskowitz From: l(b)(6) l@mac.com> O'Rourke, Peter M. Sandoval, Camilo J. ; Marc Sherman (b)(6) gmail.com>; ILJ@ frenchangel59.com> Bee: Re: [EXTERNAL] Re: Apple vs Gerner Subject: Thu Mar 08 2018 07:08:06 EST Date: 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----@mac.com] > From: Bruce Moskowitz -i(b-)(-6)-------~ > 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-I-001058 Page 177 1 of ~iYs of 1380 >> >> 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:(b)(6) ve---,A_s_s,.... is-ta_n_t_ : ..,.. M~s. ~ 6) Appo intments and Scheduling >> Executi~ >~(b)(6) @va .goL... 3v-j ....,_ (-b)-(6_) ____ ____.'--....., @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 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 >> I- VA-18-0298-I-001059 Page 1772 of ~i~ of 1380 >> 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)(6) e____ A __s_s-is-ta _ n_t_: _M_.s.l(b)(G) Appointments and Scheduling >> Executiv..__ >>!(b)(6) @va.go~v~j(-b)-(6-) ------@va.gov> Office: (202) 461-6618 >> >> >> >> >> > Questions _final.docx> I- VA-18-0298-I-001060 Page 1773 of ~i1iof 1380 Document ID: 0.7.1705.384302 From: O'Rourke, Peter M. To: Bruce Moskowitz l(b)(6) @mac .com>;Sandova l, Cami lo J. Marc Sherman (b)(6) @gmail.com> ; IP 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-)(-6)_______ 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-I-001061 Page 1774 of ~i1~ of 1380 > ------------> From: Windom, John H. > Sent: Wednesday , March 07 , 20 18 7:26:08 PM > To: Sandoval , Cami lo J. > Subject: FW: App le 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: App le 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 I > Mobile: !(b)/6) > Executive Assistant: Ms . ,.,_ !Qill-'-' )~6)._ _____ _.i - -'-A""' ppointments and Scheduling >!(b)(6) l@va.gov 4(b)(6) @va.gov > 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 > > App le will not produce an EHR/EMR. It is a hea lth record electronic file cabinet and will likely ultimately align to a commercia l EHR. App le wi ll de liver 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 .W indom@va .gov > Office : (202 461-5820 > Mobile: (b)(6) e_A _s_s-is-t-an_t_: _M __. s .~l (b_)(_ 6)______ __.I - Appointments and Scheduling > Executiv.... VA-18-0298-I-001062 Page 1775 of ~i1~ of 1380 >~l (b_)(5_>____ > ~l@va.gov!,_ (b_)(6_)______ __.l @va .gov> Office: (202) 461-6618 > > > > Questions _final.docx> VA-18-0298-I-001063 Page 1776 of ~i1~ of 1380 Document ID: 0.7.1705.384300 From: Bruce Moskowitz @mac.com> Sandoval, Camilo J. Marc Sherman kb}{6l l@gmail.com> ; IP l(b)( 6 ) 1 @frenchangel59.com>; O'Rourke, Peter M. l(b)(6) 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-I-001064 Page 1777 of ~i1iof 1380 > 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 > Mobile: l(b)(6) > Executive Assistant: Ms. l(b)(6) 1-A epointments and Scheduling >l(b)(6) @va.go.__ v...,...J (b _)_ (6-) -----~_.,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) > 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 Executive Assistant: Ms. l(b)(6) I-Appo intments and Scheduling > l(b)(6) l@va.go..... v~j(b-)(-6)-----~@va .gov> Office: (202) 461-6618 > > > > > > I VA-18-0298-I-001065 Page 177 8 of ~i1~ of 1380 Document ID: 0.7.1705.384150 Marc Sherman l(b)(6) @gmail.com> From: To: Sandoval, Camilo J. Cc: Bruce Moskowitz l(b)(6) @mac .com> ; 10fre 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-I-001066 Page 1779 of ~i1iof 1380 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..._. )(___.6 )___ __. Executive Assistant: Ms ..-l (b-)(-6)-------.I - Appointments and Scheduling l(b)(6) @va.gov<~(b)(6) @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 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 Suite 5080) Washington , DC 20420 John.Windom@va.gov Office : (202) 461-5820 Mobile: l Office: (202) 461-6618 VA-18-0298-I-001067 Page 1780 of ~i1~ of 1380 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-I-001068 Page 178 1 of t~G~ of 1380 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 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: ._l (b_)(6 _l ___ __, Executive Assistant: Ms. l._ (b_)(_ G)______ l_ (b_ )(6~ ) _____ ~I- Appointments and 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: App le vs Gerner VA-18-0298-I-001069 Page 1782 of ~i1iof 1380 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. App le 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 l(b_)(_6)___ Mobile: .... ___, Executive Assistant: Ms. l.... (b_)(6_ ) ____ l....l______ 6 (b_)(_ ~I - Appointments and Scheduling ~l@va .gov Office: (202) 461-6618 VA-18-0298-I-001070 Page 1783 of ~i1/o of 1380 Document ID: 0.7.1705.384128 From: Sandoval, Camilo J. To: Bruce Moskowitz (b) s mac .com>; Marc Sherman .... l(b_)(_6)___ 5> @frenchangel59.com> I < O'Rourke, Peter M. Bee: Subject: FW: Apple vs Gerner Date: Wed Mar 07 2018 22:46:02 EST 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: Tuesday , 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-I-001071 Page 1788 of ~i1A of 1380 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 l.... ~ _)___ Mobile: (b_)(S l(b )(6) Executive Assistant: Ms . ._ ________ (b)(6) l ...... -----~ I~ ~va.gov I __. I-Appointments and Scheduling 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-I-001072 Page 1789 of ~i~ of 1380 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 Sandoval, Camilo J. !{bl(6l To: Cc: Bee: Subject: Date: Attachments: ~gmail.com ._~_~__. @gmail.com>; O'Rourke, Peter M. 93af-o'rourke, p>; IP~ ~(b)(6) [EXTERNAL] Re: EHR Tracker Wed Mar 07 2018 18:19:31 EST 7 and 10 have serious problems that need to be addressed ASAP. 11. I have serious concerns that perhaps Chopra stat ing "this is the holy grail" does not fully understand the serious issues That does not put us even in sight of "the holy grail" . 12. Final negotiation language? How can it be Final without the new CIO input? Sent from my iPad Bruce Moskow itz M.D. On Mar 7, 2018, at 5:11 PM, Sandoval, Camilo J. wrote: Bruce/Marc, I am working with Pete and Scott to help streamline all the questions and answers we are following up on. I have consolidated everything into a word document and also pasted below. I'll continue to update this document as new questions come in. Please feel free to CC when you send new questions. Either way , I'll work directly with Pete, Scott, and the EHR team to help get accurate answers as quickly as possible. Thank you Camilo From: Blackburn, Scott R. VA-18-0298-I-001074 Page 1796 of ~i1/a of 1380 Sent: Wednesday, March 07, 2018 4:51 PM To: Sandoval , Camilo J. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Su~eci:RE:EHR-Tracker I like the idea. That way he can refine the issues he is truly concerned with (so we aren't shooting at the wrong target). Please do. Sent with Good (www.good.com) From: Sandoval , Camilo J. Sent: Wednesday, March 07, 2018 4:40 PM To: Blackburn, Scott R. Cc: O'Rourke , Peter M.; Hayes-Byrd, Jacquelyn Su~eci:RE:EHR-Tracker Scott, Okay if we also share tracker with Bruce , so we can hopefully help funnel question and catch any missing gaps? From: Blackburn, Scott R. Sent: Wednesday , March 07 , 2018 4:37 PM To: Sandoval, Camilo J. Cc: O'Rourke , Peter M.; Hayes -Byrd , Jacquelyn Su~eci:RE:EHR-Tracker Thank you . Let me share with Team so we can populate. Update - Rasu has taken a thorough scrub . Did raise a few issues that team is adjudicating. Rasu is awesome. Manis jammed this week (everyone is at HIMSS) but doing it next week he says. Sent with Good (www.good.com) VA-18-0298-I-001075 Page 1797 of t~f~ of 1380 From: Sandoval, Camilo J. Sent: Wednesday, March 07, 2018 4:24:54 PM To: Blackburn, Scott R. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Subject: EHR - Tracker Scott, See my tracker below. What additional questions are we tracking and still outstanding? EHR - Q&A Tracker Version : 3/7/2018 - 11 :51 am Category Question/Follow-up Comments 1. Personnel * CIO Candidate Pool? * Separation of roles? * #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. 2. Physician Input * Patient Centric? * Physician Usability Scope? * [ ... ] ? 3. Apple Project * Who is POC? VA-18-0298-I-001076 Page 1798 of t~f~ of 1380 * Project update? * Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? * [ .. . ] ? 4. Mobile Capabilities * Device Registry? * [ ... ] ? 5. Voice Recognition * [ ... ] * [ ... ] ? 6. Data Graphing * 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 . 7. Risk Management * 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. 8. SOAP Notes VA-18-0298-I-001077 Page 1799 of t~f~ of 1380 * Streamlining 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 . * 9. Cloud & Platform * Are we getting the cloud correctly? * Open Cloud vs. Comm. Cloud? * Open Platform vs. just AWS a. Amazon Web Services b. Cloud Providers? C. AWS Partnerships? d. DOD/CIO Team? a. 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. b. 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 Virtu Stream/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). c. 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. d. 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 service members still in uniform. 10. APls VA-18-0298-I-001078 Page 1800 of t~f~ of 1380 * Are APls cloud based? * 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 . * 11. IP Language * Clarify contract IP language This is what caused Aneesh Chopra (one of the experts on our MITRE panel) to jump out of his chair last week . He claims this is the holy grail that no other healthcare system has been able to get from either Cerner or Epic. Aneesh claims that as a result of what we've negotiated below , that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS. When I spoke to Rasu, he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge. * * 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. 12. Final Negotiation Language * [ ... 1 * 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: * 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-I-001079 Page 180 1 of t~f~of 1380 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: 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. 13. * [ ... ] * [ ... ] 14. VA-18-0298-I-001080 Page 1802 of t~S~ of 1380 ... ] * [ * [ ... ] 15. * [ ... ] * [ ... ] 16. * [ ... ] * [ ... ] Camilo Sandoval Senior Advisor to Under Secretary Veterans Health Administration U.S. Department of Veterans Affairs Washington , D.C . M: l(b)(6) 0 : 202-461-7359 VA-18-0298-I-001081 Page 1803 of ~i1~ of 1380 Document ID: 0.7.1705.475439 Bruce Moskowitz From: l@mac.com> Sandoval, Camilo J. (b)(6) @gmail.com ~----~l @gmail.com>; O'Rourke , Peter M. ; IP (b)(6) frenchangel59 .com> l(b)(6l To: Cc: Bee: Subject: Date: Attachments: l [EXTERNAL] Re: EHR Tracker Wed Mar 07 2018 18:19:31 EST 7 and 10 have serious problems that need to be addressed ASAP. 11. I have serious concerns that perhaps Chopra stating "this is the holy grail " does not fully understand the serious issues That does not put us even in sight of "the holy grail" . 12. Final negotiation language? How can it be Final without the new CIO input? Sent from my iPad Bruce Moskowitz M.D. On Mar 7, 2018, at 5:11 PM, Sandoval, Camilo J .< Camilo.Sandoval@va.gov> wrote: Bruce/Marc, I am working with Pete and Scott to help stream line all the questions and answers we are following up on. I have consolidated everyth ing into a word document and also pasted below. I'll continue to update this document as new questions come in. Please feel free to CC when you send new questions. Either way , I'll work directly with Pete, Scott, and the EHR team to help get accurate answers as quickly as possible. Thank you Camilo From: Blackburn, Scott R. Sent: Wednesday, March 07, 2018 4:51 PM VA-18-0298-I-001082 Page 1804 of ~i1~ of 1380 To: Sandoval, Camilo J . Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Su~eci:RE:EHR-Tracker I like the idea. That way he can refine the issues he is truly concerned with (so we aren't shooting at the wrong target). Please do . Sent with Good (www.good.com) From: Sandoval , Camilo J. Sent: Wednesday, March 07, 2018 4:40 PM To: Blackburn, Scott R. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Subject: RE: EHR - Tracker Scott, Okay if we also share tracker with Bruce , so we can hopefully help funnel question and catch any missing gaps? From: Blackburn, Scott R. Sent: Wednesday , March 07 , 2018 4:37 PM To: Sandoval , Camilo J . Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Su~ect:RE : EHR-Tracker Thank you. Let me share with Team so we can populate. Update - Rasu has taken a thorough scrub. Did raise a few issues that team is adjudicating. Rasu is awesome. Manis jammed this week (everyone is at HIMSS) but doing it next week he says. Sent with Good (www.good .com) VA-18-0298-I-001083 Page 1805 of t~S~ of 1380 From: Sandoval, Camilo J. Sent: Wednesday, March 07, 2018 4:24:54 PM To: Blackburn, Scott R. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacquelyn Subject: EHR - Tracker Scott, See my tracker below. What additional questions are we tracking and still outstanding? EHR-Q&A Tracker Version : 3/7/2018-11:51am Category Question/Follow-up Comments 1. Personnel * CIO Candidate Pool? * Separation of roles? * #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. 2. Physician Input * Patient Centric? * Physician Usability Scope? * [ ... ] ? 3. Apple Project * Who is POC? VA-18-0298-I-001084 Page 1806 of t~S~ of 1380 * Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? * [ ... 1? 4. Mobile Capabilities * Device Registry? * [ ... 1? 5. Voice Recognition * [ ... 1 * [ ... 1? 6. Data Graphing * 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 . 7. Risk Management * 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 successful; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented . 8. SOAP Notes * Streamlining SOAP notes? VA-18-0298-I-001085 Page 180 7 of t~S~ of 1380 Yes, the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs . * 9. Cloud & Platform * Are we getting the cloud correctly? * Open Cloud vs. Comm. Cloud? * Open Platform vs. just AWS a. Amazon Web Services b. Cloud Providers? C. AWS Partnerships? d. DOD/CIO Team? a. 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. b. 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 Virtu Stream/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). c. 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. d. 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 service members still in uniform . 10. APls * Are APls cloud based? VA-18-0298-I-001086 Page 1808 of t~S~ of 1380 * 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. 11. IP Language * Clarify contract IP language This is what caused Aneesh Chopra (one of the experts on our MITRE panel) to jump out of his chair last week . He claims this is the holy grail that no other healthcare system has been able to get from either Gerner or Epic. Aneesh claims that as a result of what we've negotiated below , that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS. When I spoke to Rasu, he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge. * * 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. 12. Final Negotiation Language * [ ... 1 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: * * 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. VA-18-0298-I-001087 Page 1809 of t~S~ of 1380 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 foste rs 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. * 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 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. * 13. * [ ... ] * [ ... ] 14. VA-18-0298-I-001088 Page 1810 of t~S~ of 1380 * [ ... ] * [ . .. ] 15. * [ ... ] * [ ... ] 16. * [ ... ] * [ ... ] Camilo Sandoval Senior Advisor to Under Secretary Veterans Health Administration U.S. Department of Veterans Affairs Washington , D.C. M: l(b)(6) 0 : 202-461-7359 VA-18-0298-I-001089 Page 1811 of ~i1iof 1380 Document ID: 0.7.1705.489580 From: Bruce Moskowitz l@mac.com> Sandoval, Camilo J. l(b)(6) lgmail.com ~----gmail.com>; O'Rourke, Peter M. l(b)(6) To: Cc: Bee: Subject: Date: Attachments: [EXTERNAL] Re: EHR Tracker Wed Mar 07 2018 18:00:30 EST Thank you very helpful Sent from my iPhone On Mar 7, 2018, at 5:11 PM, Sandoval, Camilo J. wrote: Bruce/Marc, I am working with Pete and Scott to help stream line all the questions and answers we are following up on. I have consolidated everything into a word document and also pasted below. I'll continue to update this document as new questions come in. Please feel free to CC when you send new questions. Either way, I'll work directly with Pete, Scott, and the EHR team to help get accurate answers as quickly as possible. Thank you Camilo From: Blackburn, Scott R. Sent: Wednesday, March 07, 2018 4:51 PM To: Sandoval, Camilo J. Cc: O'Rourke , Peter M.; Hayes-Byrd , Jacquelyn Su~eci:RE:EHR-Tracker VA-18-0298-I-001090 Page 1812 of ~iiiof 1380 I like the idea. That way he can refine the issues he is truly concerned with (so we aren't shooting at the wrong target). Please do. Sent with Good (www.good.com) From: Sandoval , Camilo J. Sent: Wednesday, March 07, 2018 4:40 PM To: Blackburn, Scott R. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacque lyn Su~eci:RE:EHR-Tracker Scott, Okay if we also share tracker with Bruce , so we can hopefu lly help funnel question and catch any missing gaps? From: Blackburn, Scott R. Sent: Wednesday , March 07 , 2018 4 :37 PM To: Sandoval, Camilo J. Cc: O'Rourke, Peter M.; Hayes-Byrd, Jacque lyn Su~eci:RE : EHR-Tracker Thank you . Let me share with Team so we can populate. Update - Rasu has taken a thorough scrub . Did raise a few issues that team is adjudicating. Rasu is awesome. Manis jammed this week (everyone is at HIMSS) but doing it next week he says. Sent with Good (www.good .com) From: Sandoval , Cami lo J. Sent: Wednesday , March 07 , 2018 4:24:54 PM VA-18-0298-I-001091 Page 1813 of t~9~of 1380 To: Blackburn, Scott R. Cc: O'Rourke , Peter M.; Hayes-Byrd, Jacquelyn Subject: EHR - Tracker Scott, See my tracker below. What additional questions are we tracking and still outstanding? EHR-Q&A Tracker Version : 3/7/2018 - 11 :51 am Category Question/Follow-up Comments 1. Personnel * CIO Candidate Pool? * Separation of roles? * #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. 2. Physician Input * Patient Centric? * Physician Usability Scope? * [ ... ] ? 3. Apple Project * Who is POC? * Project update? * Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? VA-18-0298-I-001092 Page 18 14 of t~9~of 1380 * [ ... ] ? 4. Mobile Capabilities * Device Registry? * [ ... ] ? 5. Voice Recognition * [ ... ] * [ ... ] ? 6. Data Graphing * How will all entered lab data from any source be avai lable 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 . 7. Risk Management * 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 successfu l; the new DoD/Cerner system has already prevented over 15,000 duplicate tests at their initial three sites that have been implemented. 8. SOAP Notes * Streamlining SOAP notes? VA-18-0298-I-001093 Page 18 15 of t~9~of 1380 * Yes, the VA/Ce rner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs. 9. Cloud & Platform * Are we getting the cloud correctly? * Open Cloud vs. Comm. Cloud? * Open Platform vs. just AWS a. Amazon Web Serv ices b. Cloud Providers? C. AWS Partnerships? d. DOD/C IO Team? a. 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. b. 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 Virtu Stream/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). c. 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 conf irmed that it will be OPEN and not proprietary to their specific AWS cloud. d. DoD is excited to fo llow our lead on all of this. I spent the morning at the Pentagon with the DoD CIO/team. Th is will help not just Veterans, but service members still in uniform. 10. AP ls * Are AP ls cloud based? * 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 enti re remote hosted VA-18-0298-I-001094 Page 18 16 of t~9~of 1380 customer base. * In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations. 11. IP Language * Clarify contract IP language * This is what caused Aneesh Chopra (one of the experts on our MITRE panel) to jump out of his chair last week . He claims this is the holy grail that no other healthcare system has been able to get from either Cerner or Epic. Aneesh claims that as a result of what we've negotiated below , that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS. When I spoke to Rasu, he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge . * 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. 12. Final Negotiation Language * [ ... l * 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: 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 informat ion/data model extension points (e.g., ingestion and record APls) with both international and national standards designating organizations. VA-18-0298-I-001095 Page 18 17 of t~S~ of 1380 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 termino logy 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. * 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 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 . * 13. * [ ... ] * [ ... ] 14. * [ ... ] * [ ... ] VA-18-0298-I-001096 Page 1818 of t~9~of 1380 15. * [ ... ] * [ ... ] 16. * [ ... ] * [ ... ] Camilo Sandoval Senior Advisor to Under Secretary Veterans Health Administration U.S. Department of Veterans Affairs Washington, D.C. M: l(b)(6) 0: 202-461-7359 VA-18-0298-I-001097 Page 18 19 of ~i1~ of 1380 Document ID: 0.7.1705.475408 From: Bruce Moskowitz @mac.com> Sandoval, Camilo J. (b)(6) @gmail.com ~----~l @gma il.com>; O'Rourke , Peter M. l(b)(6) To: Cc: Bee: Subject: Date: Attachments: l [EXTERNAL] Re: EHR Tracker Wed Mar 07 2018 18:00:30 EST Thank you very helpful Sent from my iPhone On Mar 7, 2018, at 5:11 PM, Sandoval , Camilo J. wrote: Bruce/Marc, I am working with Pete and Scott to help stream line all the questions and answers we are following up on. I have consolidated everyth ing into a word document and also pasted below. I'll continue to update this document as new questions come in. Please feel free to CC when you send new questions. Either way, I'll work directly with Pete, Scott, and the EHR team to help get accurate answers as quickly as possible. Thank you Camilo From: Blackburn, Scott R. Sent: Wednesday , March 07 , 2018 4:51 PM To: Sandoval, Camilo J. Cc: O'Rourke , Peter M.; Hayes-Byrd , Jacquelyn Su~ect:RE:EHR-Tracker VA-18-0298-I-001098 Page 1820 of ~iiiof 1380 I like the idea . That way he can refine the issues he is truly concerned with (so we aren't shooting at the wrong target). Please do. Sent with Good (www.good .com) From: Sandoval , Cam ilo J. Sent: Wednesday, March 07, 2018 4 :40 PM To: Blackburn , Scott R. Cc: O'Rourke, Peter M.; Hayes-By rd, Jacque lyn Subject: RE: EHR - Tracker Scott, Okay if we also share tracker with Bruce , so we can hopefu lly help funne l question and catch any missing gaps? From: Blackburn, Scott R. Sent: Wednesday , March 07 , 2018 4 :37 PM To: Sandova l, Camilo J . Cc: O'Rourke , Peter M.; Hayes-Byrd , Jacque lyn Su~ect:RE:EHR-Tracker Thank you. Let me share with Team so we can populate. Update - Rasu has taken a thorough scrub . Did raise a few issues that team is adjudicating. Rasu is awesome. Manis jammed this week (everyone is at HIMSS) but do ing it next week he says. Sent with Good (www .good .com) From: Sandoval , Cami lo J. Sent: Wednesday, March 07, 2018 4 :24 :54 PM To: Blackburn, Scott R. Cc: O'Rourke , Peter M.; Hayes-By rd , Jacque lyn VA-18-0298-I-001099 Page 1821 of t~9~of 1380 Subject: EHR - Tracker Scott, See my tracker below. What additional questions are we tracking and still outstanding? EHR-Q&A Tracker Version : 3/7/2018 - 11:51am Category Question/Follow-up Comments 1. Personnel * CIO Candidate Pool? * Separation of roles? * #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 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 . 2. Physician Input * Patient Centric? * Physician Usability Scope? * [ ... ] ? 3. Apple Project * Who is POC? * Project update? * Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? VA-18-0298-I-001100 Page 1822 of t10~of 1380 * [ ... ] ? 4. Mobile Capabilities * Device Registry? * [ ... ] ? 5. Voice Recognition * [ ... ] * [ ... ] ? 6. Data Graphing * 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 . 7. Risk Management * 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 mon itor, via report . The med duplication is configured similarly to tes t 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 . 8. SOAP Notes * Streamlining SOAP notes? VA-18-0298-I-001101 Page 1823 of t10~of 1380 Yes, the VA/Cerner system will have this. These are provided and will be further configured under VA direction to meet VA clinician needs . * 9. Cloud & Platform * Are we getting the cloud correctly? * Open Cloud vs. Comm . Cloud? * Open Platform vs. just AWS a. Amazon Web Services b. Cloud Providers? C. AWS Partnerships? d. DOD/CIO Team? a. 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. b. 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 Virtu Stream/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). c. 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. d. 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 service members still in uniform . 10. APls * Are APls cloud based? 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. * VA-18-0298-I-001102 Page 1824 of t10~of 1380 * In a recent press release Cerner and Amazon announced that they would be working together in cooperation to accelerate HealthCare Innovations . 11. IP Language * Clarify contract IP language This is what caused Aneesh Chopra (one of the experts on our MITRE panel) to jump out of his chair last week . He claims this is the holy grail that no other healthcare system has been able to get from either Cerner or Epic. Aneesh claims that as a result of what we've negotiated below , that other healthcare systems will be willing to join us in the attached pledge (shall we decide to go forward with it) and we could do this next week at HiMSS. When I spoke to Rasu, he told me Aneesh had already called him about this and that UPMC would be willing to sign this pledge. * * Of importance: Third[MJT1] party API developers shall retain their IP rights when thei r 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 outside of VA. 12. Final Negotiation Language * [ ... l * 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: * Understand how Cerner will provide the VA with access to the data model, share data for analytics free ly 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 extens ion 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 VA-18-0298-I-001103 Page 1825 of t10~of 1380 providers. * Suggest adding to RFP Section 5.8: "h) Provide the VA EHRM data model, underpinning terminology model, tables, definitions, and examp les 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. * 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 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. 13. * [ .. . ] * [ ... ] 14. * [ ... ] * [ .. . ] 15. VA-18-0298-I-001104 Page 1826 of t10~of 1380 ... ] * [ * [ ... ] 16. * [ ... ] * [ ... ] Camilo Sandoval Senior Advisor to Under Secretary Veterans Health Administration U.S. Department of Veterans Affairs Washington, D.C. M: l(b)(6) 0: 202-461-7359 VA-18-0298-I-001105 Page 1827 of ~ 1b~of 1380 Document ID: 0.7.1705.487678 From: Blackburn, Scott R. To: Sandoval, Camilo J . Cc: Bee: Subject: RE: [EXTERNAL ] Fwd: EMR Date: Wed Mar 07 2018 02:44:40 EST Attachments: I like it. Will do. Also just forwarded what we shared with Bruce last week . We are close. We will get the re. Bruce seems positive. I am hopeful Rasu and Manis will help. From: Sandoval, Camilo J. Sent: Tuesday , March 06, 20 18 7:12 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] Fwd: EMR Is Bruce 's email one of the questions you think we've already answered in the past? Can I offer a suggestion? Could we possibly create a tracker on all the incoming questions/answers? I believe this might clarify the question and help get a quicker reply and keep everyone on the same page . Example below based on what Bruce requested today. Thoughts? Question/Topic Follow-Up Questions Response/Comments 1. Cloud Are we getting the cloud correctly Document reference? VA-18-0298-I-001106 Page 1828 of t10~of 1380 Strategy? POC? 2. CIO Candidate Pool? Key Qualificat ions? Separation of roles? 3. Physician Input Patient Centric? Physician Usabi lity Scope? 4. 5. App le Project Who is POC? Project update? Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community ? 6. 7. VA-18-0298-I-001107 Page 1829 of t10~of 1380 From: Blackburn, Scott R. Sent: Tuesday , March 06 , 2018 5:05 PM To: Sandoval , Camilo J . Subject: FW: [EXTERNAL] Fwd: EMR 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 l(b)( 6 ) ~mac .com > Date: March 5, 2018 at 6:49 :58 AM EST To: l(b)(6) @gmail.com, (bl(6 reagan .com .-----, 5 Cc: ~---~l @gmail.com, I (b>C >@frenchangel59.com >, l(b)( 6 ) 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-I-001108 Page 1830 of ~1bi of 1380 Document ID: 0.7.1705.487677 From: Blackburn, Scott R. To: Sandoval, Camilo J . Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Wed Mar 07 2018 02:44:40 EST Attachments: I like it. Will do. Also just forwarded what we shared with Bruce last week . We are close. We will get there. Bruce seems positive. I am hopeful Rasu and Manis will help. From: Sandoval , Camilo J. Sent: Tuesday , March 06 , 2018 7:12 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] Fwd : EMR Is Bruce's email one of the questions you think we 've already answered in the past? Can I offer a suggestion? Could we possibly create a tracker on all the incoming questions/answers? I believe this might clarify the question and help get a quicker reply and keep everyone on the same page. Example below based on what Bruce requested today. Thoughts? Question/Topic Follow-Up Questions Response/Comments 1. Cloud ********* Are we getting the cloud correctly ********* Document reference ? VA-18-0298-I-001109 Page 183 1 of t10~of 1380 ********* Strategy? ********* POC? 2. CIO ********* Candidate Pool? ********* Key Qualifications? ********* Separation of roles? ********* 3. Physicia n Input ********* Patient Centric? ********* Physician Usab ility Scope? ********* ********* 4. ********* ********* 5. App le Project ********* Who is POC? ********* Project update? ********* Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? ********* 6. ********* ********* 7. ********* ********* VA-18-0298-I-001110 Page 1832 of t1l~of 1380 From: Blackburn, Scott R. Sent: Tuesday , March 06 , 2018 5:05 PM To: Sandoval , Camilo J. Subject: FW: [EXTERNAL] Fwd: EMR 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 l(b)(G) la>,mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com, b 6 reagan .com 5 Cc: ~----~ ~gmail.com , I < > frenchangel59 .com> j(b)(G) Su~eci:EMR --- ~gmail. com 1 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-I-001111 Page 1833 of ~ ~~ of 1380 1 Document ID: 0.7.1705.475262 From: Blackburn, Scott R. To: Sandoval, Camilo J . Cc: Bee: Subject: RE: [EXTERNAL ] Fwd: EMR Date: Wed Mar 07 2018 02:44:40 EST Attachments: I like it. Will do. Also just forwarded what we shared with Bruce last week . We are close. We will get the re. Bruce seems positive. I am hopeful Rasu and Manis will help. From: Sandoval, Camilo J. Sent: Tuesday , March 06, 20 18 7:12 PM To: Blackburn, Scott R. Subject: RE: [EXTERNAL] Fwd: EMR Is Bruce 's email one of the questions you think we've already answered in the past? Can I offer a suggestion? Could we possibly create a tracker on all the incoming questions/answers? I believe this might clarify the question and help get a quicker reply and keep everyone on the same page . Example below based on what Bruce requested today. Thoughts? Question/Topic Follow-Up Questions Response/Comments 1. Cloud ********* Are we getting the cloud correctly ********* Document reference ? VA-18-0298-I-001112 Page 1834 of t1l~of 1380 ********* Strategy? ********* POC? 2. C IO ***** **** Candidate Pool? ********* Key Qual ificat ions? ********* Separation of roles? ********* 3. Physician Input ********* Patient Centric? ********* Physician Usability Scope? ********* ********* 4. ********* ********* 5. App le Project ********* Who is POC? ********* Project update? ********* Menta l Health Strategy and Portab le EMR Solution that works with DOD & VA & Community? ********* 6. ********* ********* 7. ********* ********* VA-18-0298-I-001113 Page 1835 of t1l~of 1380 From: Blackburn, Scott R. Sent: Tuesday , March 06 , 2018 5:05 PM To: Sandoval , Camilo J . Subject: FW: [EXTERNAL] Fwd: EMR 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 l(b)(6) @mac .com > Date: March 5, 2018 at 6:49 :58 AM EST To: I(b)(6) gJgmail.com, (bl(6l reagan .com~--~ Cc:.____ _.r@gmail.com, IP (b)(6 )@frenchangel59.com > j(b)(S) 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 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-I-001114 Page 1836 of ~ 1~iof 1380 Document ID: 0.7.1705.487663 From: Blackburn, Scott R. Sandova l, Cami lo 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)(G) @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)(6) @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-I-001115 Page 1837 of ~1 ~~ of 1380 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' l@gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M. ; IP: l(b)(6 ) 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(b_)(_5 l_______ ___.l @mac.com] VA-18-0298-I-001116 Page 1838 of ~ 1~iof 1380 Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP;l(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: 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-I-001117 Page 1839 of ~1 ~~ of 1380 DoD CIO/team. This will help not j ust 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)(6) @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)(6) 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. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l (b_)(_6)_____ ~ @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"""' )(.6) __ '-- ____ On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz .._l __,@mac.com> wrote: This is a prob lem it should say open cloud to all entities not commercial cloud VA-18-0298-I-001118 Page 1840 of ~ 1~iof 1380 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 language that we negotiated . l(b)( 5) (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-I-001119 Page 1841 of ~ 1~iof 1380 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-I-001120 Page 184 2 of t12~of 1380 Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001121 Page 1843 of t12~of 1380 Document ID: 0.7.1705.474783 Blackburn, Scott R. Sandoval, Camilo J. Cc: Bee: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Date: Wed Mar 07 2018 02:43:22 EST Attachments: From: Bruce Moskowitz l(b)(S) @mac.com] Sent: Wednesday , February 28, 2018 4 :53 PM To: Blackburn , Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP: l(b)(6) @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-I-001122 Page 1844 of ~ 11~of 1380 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' Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP;l(b)(6) @gmail.com 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~)(~ 6)_______ From: Bruce Moskowitz ..... Sent: Wednesday , February 28, 20181:13 PM ~ @mac.com] VA-18-0298-I-001123 Page 1845 of ~ 11~of 1380 To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(6) 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 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-I-001124 Page 1846 of ~11iof 1380 Thanks again for the feedback and support. We are going to make sure this is crystal clear . Scott From: Bruce Moskowitz l(b)(6) 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; ! 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. l(b_)(_6)_____ 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 . VA-18-0298-I-001125 Page 184 7 of ~ 11~of 1380 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. I #3) Below is the IP language that we negotiated. l(b)(5 ) (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-I-001126 Page 1848 of ~11iof 1380 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-I-001127 Page 1849 of t12~of 1380 Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation. -Scott VA-18-0298-I-001128 Page 1850 of t12~of 1380 Document ID: 0.7.1705.383963 Sandoval, Camilo J. O'Rourke, Peter M. Cc: Hayes -Byrd, Jacquelyn Bee: Subject: FW: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 19:12:57 EST Attachments: FYI. .. From: Sandoval , Cam ilo J. Sent: Tue sday, March 06 , 20 18 7:12 PM To: Blackburn, Scott R. Subject: RE : [EXTERNAL] Fwd: EMR Is Bruce 's ema il one of the questions you think we've already answered in the past? Can I offer a suggestion? Could we possibly create a tracker on all the incoming questions/answers? believe this might clarify the question and help get a quicker reply and keep eve ryon e on the same page. Example below based on what Bruce requested today. I Thoughts? Question/Topic Follow-Up Questions Response/Comments 1. Cloud ********* Are we getting the cloud correctly **** ***** Document reference ? VA-18-0298-I-001129 Page 185 1 of t12~ of 1380 ********* Strategy? ********* POC? 2. C IO ***** **** Candidate Pool? ********* Key Qual ificat ions? ********* Separation of roles? ********* 3. Physician Input ********* Patient Centric? ********* Physician Usability Scope? ********* ********* 4. ********* ********* 5. App le Project ********* Who is POC? ********* Project update? ********* Menta l Health Strategy and Portab le EMR Solution that works with DOD & VA & Community? ********* 6. ********* ********* 7. ********* ********* VA-18-0298-I-001130 Page 1852 of t 1j~ of 1380 From: Blackburn, Scott R. Sent: Tuesday , March 06 , 2018 5:05 PM To: Sandoval , Camilo J . Subject: FW: [EXTERNAL] Fwd: EMR 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: From: Bruce Moskowitz .... l(b_)(_6)_____ __,@mac .com > Date: March 5, 2018 at 6:49 :58 AM EST To: l(b)(6) ©gmail:com , (b)(6) Cc: ..... ___ _.l@gma1l.com'-, ,..,..r,<5;:-;> ,,.._.,,..-----.-' Subject: EMR I would like to underscore the importance of getting the "Cloud "correctly and the other four issue s 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 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-I-001131 Page 1853 of ~ 11~of 1380 Document ID: 0.7.1705.383940 From: Sandoval, Camilo J. To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL ] Fwd: EMR Date: Tue Mar 06 2018 19:12:29 EST Attachments: Is Bruce's email one of the questions you think we've already answered in the past? Can I offer a suggestion? Could we possibly create a tracker on all the incoming questions/answers? believe this might clarify the question and help get a quicker reply and keep everyone on the same page. Example below based on what Bruce requested today. I Thoughts? Question/Topic Follow-Up Questions Response/Comments 1. Cloud ********* Are we getting the cloud co rrectly ********* Document reference ? ********* Strategy? ********* POC? 2. C IO ********* Candidate Pool? ********* Key Qualifications? VA-18-0298-I-001132 Page 1854 of t 1j~ of 1380 ********* Separation of roles? ********* 3. Physician Input ********* Patient Centric? ********* Physician Usab ility Scope? ********* ********* 4. ********* ********* 5. Apple Project ********* Who is POC? ********* Project update? ********* Mental Health Strategy and Portable EMR Solution that works with DOD & VA & Community? ********* 6. ********* ********* 7. ********* ********* From: Blackburn, Scott R. Sent: Tuesday , March 06, 2018 5:05 PM To: Sandova l, Camilo J. Subject: FW : [EXTERNAL] Fwd : EMR VA-18-0298-I-001133 Page 1855 of t13~of 1380 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: @mac.com> From: Bruce Moskowitz l(b)(6) Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gm ail.com, (b)(6) @reagan.com .------. renchangel59.com> ,l(b)(6) Cc: .,.... -~-:-=--~ @gmail.com, IP r,x5> 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-I-001134 Page 1856 of ~1\iof 1380 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: From: Bruce Moskowit ~(b)(G) @mac.com> Date: March 5, 2018 at 6:49 :58 AM EST To: l(b)(6) jygmail.com, l(b)(6) @reagan .com ---~ Cc:.__~~_.! @gmail.com, IFE:] @frenchangel59.com>, l(b)(6) 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-I-001135 Page 1857 of ~ 11~of 1380 Document ID: 0.7.1705.487153 From: Blackburn, Scott R. To: Sandoval, Camilo 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 , 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(b)(S) Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com , (b)(6 reagan .com 5 tmgmail.com, IP (b>< > frenchangel59 .com> J .(b .... _J(_5l__ Cc: ._____ 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-I-001136 Page 1859 of ~1\iof 1380 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: [EXTERNAL] Fwd: EMR Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: 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-I-001137 Page 186 1 of ~ 11~of 1380 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 1(b)(6) Sent with Good (www.good .com) From: Myklegard , Drew Sent: Tuesday , March 06 , 2018 6:02:25 AM To: Blackburn, Scott R.;l(b)(6) Subject: Re: [EXTERNAL] Fwd: EMR I 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 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 wa lk you through the Veteran/patient experience and how it will 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." VA-18-0298-I-001138 Page 1863 of ~1\iof 1380 Date: Tuesdav March 6, 2018 at 5:42 AM To: l(b)(6) ~ @va.gov> , "Myklegard, Drew" Subject: FW: [EXTERNAL] Fwd : EMR 0 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: @mac .com> From: Bruce Moskow itz l(b)(6) Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com , b s reagan .com 6 Cc:,_ ____ _, @gmail.com, 1pcb>( > frenchangel59.com> ,._l (b_)(_6l_ _.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 . Sent from my iPad Bruce Moskowitz M.D. VA-18-0298-I-001139 Page 1864 of ~1\iof 1380 Document ID: 0.7.1705.1492397 From: !(b)(G) l To: Blackburn, Scott R. ; 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, 2018 5:42:23 AM Myklegard, Drew To :l(b)(G) 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-I-001140 Page 1865 of ~1\iof 1380 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 cha nge 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-I-001141 Page 1866 of ~ 1\~of 1380 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-I-001142 Page 1867 of t14~of 1380 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 (b_)(6 _l ___ Mobile: ~l ~ Executive Assistant: Ms. ~l (b_)(_6 l______ ~l (b_)(6_ ) ____ ~l@va.gov ~I- Appointments and Schedu ling 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-I-001143 Page 1868 of ~ 1\~of 1380 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(b)(6) l@mac .com> Date: March 5, 2018 at 6:49 :58 AM EST To : l(b)(6) ~gm ail.com, l1hvs, @reagan.com ~--~ Cc: ~---~ @gmail.com, 1t=E:] @frenchangel59 .com> l(b)(6) Subject: EMR l@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-I-001144 Page 1869 of ~1\iof 1380 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-I-001145 Page 1870 of t1l~of 1380 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 (b_)(G_ J___ Mobile: l._ ___. Executive Assistant: Ms.~l (b-)(-G )------~~ l~ (b_)(6_l ____ Appointments and Scheduling ~ @va .gov Office: (202) 461-6618 From: Blackburn, Scott R. Sent: Tuesday , March 06 , 2018 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? VA-18-0298-I-001146 Page 187 1 of ~1\iof 1380 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: @mac .com> From: Bruce Moskowitz l(b)(6) Date: March 5, 2018 at 6:49 :58 AM EST To: l(b)(6) ~gmail.com , b s @reagan .com ~--~ 5> Cc:._ ____ __,@gmail.com, IP(b>< frenchangel59 .com> ,l(b)(6) Subject: EMR l@gmail.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 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-I-001147 Page 1872 of ~ 1\~of 1380 Document ID: 0.7.1705.1208671 From: Windom, John H. To: Blackburn, Scott R. ; Zenooz, Ashwini ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 09:16:13 EST 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 Mobile:...,!(b~) (~6) ___ ~ Executive Assistant: Msl._ (b_)(_6 )______ l(b_)(6_ .... )____ __. @va.gov ~1- Appointments and Scheduling Office: (202) 461-6618 VA-18-0298-I-001148 Page 1873 of ~1\iof 1380 From: Blackburn, Scott R. Sent: Tuesday , March 06, 2018 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) 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 !ibJ<6l @mac .com> Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com , b 6 reagan.com .-----. x•> frenchangel59 .com> ,l(b)(6) Cc:._ ____ _.l@gmail.com, IP Cb 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-I-001149 Page 1874 of ~1\iof 1380 Document ID: 0.7.1705.1492041 Myklegard, Drew Blackburn, Scott R. ;-l(b_)(_6l_~ (b)(6) /o=va/ou =exchange 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 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 @va.gov> , "Myklegard, Drew" To: l(b)(6) 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-I-001150 Page 1875 of ~ 1Ycof 1380 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: @mac .com> From: Bruce Moskow itz l(b)(6) Date: March 5, 2018 at 6:49 :58 AM EST !:ggmail.com, (b)(6) reagan .com .---. To : l(b)(6) ....,l @gmail.com, I ~b)(6 frenchangel59 .com> , l(b)(G) Cc: .____ 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-I-001151 Page 1876 of ~ ~ of 1 1380 Document ID: 0.7.1705.1763804 From: Blackburn, Scott R. To: l(b)(6) l Cc: Bee: Subject: FW: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 08:42:23 EST Attachments: 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 l(b)(6) @mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gm ail.com , b 6 reagan .com .------, Cc:~---~ @gmail.com, IP(b)(6 frenchangel59.com> ,l(b)(6) Subject: EMR t@.gmail.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-I-001152 Page 1877 of ~1 ~ of 1380 Sent from my iF?ad Bruce Moskowitz MD. 153 Page 1873 ?5 of 1380 Document ID: 0.7.1705.485961 From: Blackburn, Scott R. To: l(b)(6) (Disabled) ; Myklegard , Drew Cc: Bee: Subject: FW: [EXTERNAL] Fwd: EMR 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: 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 VA-18-0298-I-001154 Page 1879 of ~ 1Y}iof 1380 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-I-001155 Page 1880 of t 15~of 1380 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 email below. Any thoughts on how to respond? Sent with Good (www .good .com) From: David Shulk in 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(b)(6) Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com, b s reagan.com Cc:~.---~ @gmail.com, IP(bxo> frenchangel59 .com> ,._l (b_)(_6)_ __,l@gmail.com Subject: EMR I would like to underscore the importance of getting the "Cloud "correctly and the other four issues with VA-18-0298-I-001156 Page 1881 of ~ ~ of 1 1380 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-I-001157 Page 1882 of t15~of 1380 Document ID: 0.7.1705.1208625 From: Blackburn, Scott R. To: 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 l(b)(6) @mac.com> Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gm ail.com , b s reagan .com .-----. Cc: ~---~ @gmail.com, IP(b)(6 frenchangel59.com> ,l(b)(6) 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 . VA-18-0298-I-001158 Page 1883 of ~ 1Ysof 1380 Sent from my iF?ad Bruce Moskowitz MD. 159 Page 1884 of 1380 Document ID: 0.7.1705.485695 From: David Shulkin l,(b-)(6 _)__ _,@gma il.com> To: Blackburn, Scott R. Cc: Bee: Subject: [EXTERNAL] Fwd: EMR Date: Tue Mar 06 2018 07:09:43 EST Attachments: Can we begin to address and then ill respond back? Sent from my iPhone Begin forwarded message: @mac.com> From: Bruce Moskowitz l(b)(6) Date: March 5, 2018 at 6:49:58 AM EST To: l(b)(6) ~gmail.com , b s reagan .com 6)__ Cc:~.---~ ~gmail.com, I (b>(5> frenchangel59 .com>,~l (b_)(_ Subject: EMR @gmail.com I would like to underscore the importance of getting the "Cloud"correct ly and the other four issues with the new Cl O'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 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-I-001160 Page 1885 of ~11iof 1380 Document ID: 0.7.1705.1763619 From: Blackburn, Scott R. To: Dumbauld, Cassidy M. EOP/WHO l(b)(6) l@who.eop.gov> l(b)(6) l Bee: Subject: RE: [EXTERNAL] RE: interoperability Date: Mon Mar05201816:31:37 EST Attachments: lwill help schedule time . Sounds goodl(bJ(BJ 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) From: Dumbauld , Cassidy M. EOP/WHO 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 Ito schedule! work withl(b)(6) -----Original Message----From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 4:15 PM (b-)(-6)-------, To: Dumbauld, Cassidy M. EOP/WHO .-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: Dumbauld, Cassidy M. EOP/WHO Sent: Monday, March 05, 2018 10:55:04 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO;..._l (b...... )(~6)________ Subject: [EXTERNAL] RE: interoperability ...., VA-18-0298-I-001161 Page 1886 of ~ 11~of 1380 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 A (b)(G) To: Dumbauld , Cass idy M. EOP/WH who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>;l(b)(6) l(b)(6) 1@va.gov> .____________ __, Subject: RE: interoperability Hi Cassidy, 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: Dumbau ld, Cassidy M. EOP/WH ri (b)(G) Sent: Sunday, March 04, 201811:30 AM__ ________ To: Blackburn, Scott R. l(b)(G) Cc: Berkowitz, Avrahm J. EOP/WHO; .________ 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? Great. We will find time . From: Kushner , Jared C. EOP/WHO l(b)(6) l@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 Yes - perhaps we can schedu le for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner , Jared C. EOP/WHO (b)(6 who.eop .gov (b)(6) @who.eop.gov>> Cc: Berkowitz, Avrahm J. EOP/WHO( b)(6) who.eop .g· ':":: o:-:-vl":: (b ~)":":: (6":"" ) -...::::...., ,,,,..who.eop.gov>> VA-18-0298-I-001162 Page 1887 of ~ 11~of 1380 Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time th is week. Scott Scott Blackburn Acting CIO & Executive-in-Charge, Department of Veterans Affairs Office of Information & Technology VA-18-0298-I-001163 Page 1888 of t1S~of 1380 Document ID: 0.7.1705.485102 From: Blackburn , Scott R. To: Dumbauld, Cassid M. EOP/WHO (b)(6) who.eop .gov> (b)(6) Cc: Subject: RE: [EXTERNAL] RE: interoperability Available anytime now. Just standing by whenever Jared is ready. Sent with Good (>www .good.com<) From: Dumbauld , Cassidy M. EOP/WHO Sent: Monday, March 05, 2018 10:55:04 AM To: Blackburn, Scott R. 6l_____ Cc: Berkowitz, Avrahm J. EOP/WHO ;i~(b_)(_ ~ VA-18-0298-I-001164 Page 1889 of ~11iof 1380 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: Sunday, March 4 , 2018 11 :35 AM_______ To: Dumbauld , Cassidy M. EOP/WH ~ @who eop qoy > who.eop.gov>; l(b)(G) Cc: Berkowitz, Avrahm J. EOP/WH ~ l@va.gov> ~---------~ l(b)(G) Subject: RE : interoperability Hi Cassidy, 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 6)_______ (b_)(_ From: Dumbauld , Cassidy M. EOP/WHO ._l Sent: Sunday, March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ;I..,., (b,.,.. )(_6)_____ Subject: [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. [mailto :Scott.Blackburn@va.gov] Sent: Wednesday , February 28, 2018 9:15 PM To: Kushner , Jared C. EOP/WHO (b)(G) who.eop.go ~(b)(G) Cc: Berkowitz , Avrahm J. EOP/WH (b)(G) who.eop. '= go::-: v~ == b'..Jj =..:::.. 6=:_=:_: =:,-:i~ ..:..:....:...=..:...::=.c= :....:...,___._ ===; ChristoRher P. EOP/WHO (b)(G) who .eop~. z..= o....:.i.;... (b....;. )(6 ....;. )______ ---,-:::--~who .gov>>; (b)(G) va .go ."'(b ....:. )-'(6-') --------"'--' Subject: RE : interoperability .eop Great. We will find time . From: Kushner, Jared C. EOP/WHO l(b)(G) @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 Yes - perhaps we can schedu le for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM who.eop .gov .... l(b_)(_ G)_ ____. l@who.eop .gov>> To: Kushner , Jared C. EOP/WHO ~ VA-18-0298-I-001165 Page 1890 of ~ 11~of 1380 Cc: Berkowitz, Avrahm J. EOP/WHO ~ Subject: interoperability who.eop .gov l(b)(6) ...____ l@who.eop .gov>> _, Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so , let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive -in-Charge, Office of Informat ion & Te chnology Department of Veterans Affairs VA-18-0298-I-001166 Page 1891 of ~11iof 1380 Document ID: 0.7.1705.485097 From: Dumbauld, Cassidy M. EOP/WHO l(b)(6) @who.eop.gov> To: Blackburn , Scott R. Cc: Bee: RE: [EXTERNAL] RE : interoperability Subject: Mon Mar 05 2018 16:15 :39 EST Date: Attachments: Scott - I a olo ize. Jared believes it's better to speak in person about this when you all are back. I'll work with (b)(6) to schedule! -----O riginal Message- ---From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 4:15 PM To: Dumbauld , Cassidy M. EOP/WHO ,-l (b-)(-6)-------. 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: Dumbauld , Cassidy M. EOP/WHO Sent: Monday, March 05, 2018 10:55 :04 AM To: Blackburn, Scott R. 6)_____ ..,, )(_ Cc: Berkowitz, Avrahm J . EOP/WHO; l.(b,,..,. 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: Sunday, March 4, 2018 11 :35 AM l(b-)(-6)------~ @who .eoo .aov> To: Dumbauld , Cassidy M. EOP/WHO ,Cc: Berkowitz, Avrahm J. EOP/WH ~ who.eop.gov>; l(b)(6) l(b)(6) l@va.gov> ~---------~ Subject: RE : interoperability Hi Cassidy, 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 VA-18-0298-I-001167 Page 1892 of ~ 11~of 1380 (202) 430-9139 (b)(6) From: Dumbauld , Cassidy M. EOP/WH ~---------~ Sent: Sunday , March 04 , 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO l~ (b_)(5_)_____ Subject: [EXTERNAL] RE: interoperability I_ @who.eop.gov] d ~ 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 Subject: RE : interoperability Great. We will find time . l@who.eop .gov] From : Kushner, Jared C. EOP/WHO l(b)(6) 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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Monday , February 26 , 2018 5:05 PM (b-:'"'" )(;:::::: 6)== To: Kushner, Jared C. EOP/WHO (b)( who.eop.go Vl:-: Cc: Berkowitz, Avrahm J . EOP/WH (b)(6) who .eop .go ~(b)(6) Subject: interoperability ~ :.... who.eop .gov>> @who.eop .gov>> Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . 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-I-001168 Page 1893 of ~11iof 1380 Document ID: 0.7.1705.485095 From: Blackburn, Scott R. To: 011rnba11ldCassidv ~~ EOP/WHO l(b)(S) who.eop.gov> Cc: Bee: RE: [EXTERNAL] RE: interoperability Subject: Mon Mar 05 2018 16:14:49 EST Date: Attachments: Available anytime now . Just standing by whenever Jared is ready. Sent with Good (www.good .com) From: Dumbauld , Cassidy M. EOP/WHO Sent: Monday, March 05, 2018 10:55:04 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; l(b)(S) Subject: [EXTERNAL] RE: interoperab...... 1l =1ty -----~ 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. [mailto:Scott.Blackburn@va.gov] Sent: Sunday , March 4, 2018 11:35 AM ~------~ To: Dumbauld, Cassidy M. EOP/WHO (b)(6) who .eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>; (b)(6) l(b)(6) @va.gov> .___________ __. Subject: RE: interoperability Hi Cassidy , 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 VA-18-0298-I-001169 Page 1894 of ~11iof 1380 could also do it there. Let me know. Scott (202) 430 -9139 5 From: Dumbauld , Cassidy M. EOP/WHO ..... l(b_)(_ l_______ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn , Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; ._l (b_)(_6l______ 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/WHO (b)(6 who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop. ov>; Liddell, Christopher P. EOP/WHO l(b)(6) @who.eop.gov> ; (b)(6) va.gov> Subject: RE : interoperability Great. We will find time . From: Kushner, Jared C. EOP/WHO l(b)(S) @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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM VA-18-0298-I-001170 Page 1895 of ~ of 11/o 1380 To: Kushner, Jared C. EOP/WHO ~ Cc: Berkowitz, Avrahm J. EOP/WH~ Subject: interoperability who.eop .gov> who.eop .gov> Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001171 Page 1896 of ~ 11Aof 1380 Document ID: 0.7.1705.1489544 From: Dumbauld, Cassidy M. EOP/WHO (b)(6) @who. eop.gov> To: .__--,--..,.......,..---,--------' f /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Berkowitz, Avrahm J. EOP/WHO Cc: .-l (b-)(6_ ) ___._,l @who .eop.gov>; Blackburn, Scott R. Bee: Subject: [EXTERNAL] RE: interoperability Date: Mon Mar 05 2018 12:06:04 EST Attachments: l That is no problem! 6 From:~l (b,-)(_)-,---e-,-..,_.,=--=.,,..,..,_,...,,,_,,.. =-=-e-,--------' @va .gov] Sent: Monday, March 5, 2018 12:05 Pr. M-:-:-::-:--------, To: Dumbauld, Cassidy M. EOP/WHQ( b)(6) who .eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>; Blackburn , Scott R. Subject: RE: interoperability Importance: High Hi Cassidy , would it be possible for Mr. Kushner to call Scott after 3:30 PM EST? He will be wrapping up speaking at HIMSS before that and may be still taking audience questions at 3PM. Thanks so much! ~ Moblie :~l (b_)(_6 )___ ~ 5 From: Dumbauld , Cassidy M. EOP/WHO '~ (b_)(_l________ Sent: Monday, March 05 , 2018 8:29 AM To : Blackburn, Scott R. (b..,.... )(6 _)_____ Cc: Berkowitz, Avrahm J. EOP/WHO; l~ Subject: [EXTERNAL] RE: interoperability ~@who .eop.gov] ___, Great he will speak with you soon! VA-18-0298-I-001172 Page 1897 of ~ ~ of 1 1380 From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 11:14 AM ._______ __ 6 To: Dumbauld , Cassidy M. EOP/WHO (b)( ) who .eo . ov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>;( b)(6) l(b)(6) @va.gov> ~----------~ 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. 5 From: Dumbauld, Cassidy M. EOP/WH Q,,_ ~b -)(_l________ Sent: Monday, March 05 , 2018 10:55 AM To: Blackburn, Scott R. ~b= )(,6)_____ Cc: Berkowitz , Avrahm J . EOP/WHO j!-, Subject: [EXTERNAL] RE : interoperability ~ @who .eo p.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 ~------~ To: Dumbauld , Cassidy M. EOP/WHO (b)(6) @who.eop.gov> who.eop.gov> j(b)(6) Cc: Berkowitz , Avrahm J. EOP/WH (b)(6) l(b)(6) l@va.gov> ..... -----------~ Subject: RE: interoperability Hi Cassidy, 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 could also do it there. Let me know. Scott (202) 430-9139 VA-18-0298-I-001173 Page 1898 of ~ ~ of 1 1380 (b)(6) From: Dumbauld , Cassidy M. EOP/WH .__________ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ;...,.l (b,.,... )(_6)_____ Subject: [EXTERNAL] RE: interoperability I_ d _.,@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 (b)(6 who.eop.gov > Cc: Berkowitz , Avrahm J. EOP/WH (b)(6) who.eop .gov>; Liddell, Christopher P. EOP/WHO l(b)(6) @who .eop .gov> ;!(b)(6) @va .gov> Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO l(b)(6) l@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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM who.eop .gov> To: Kushner , Jared C. EOP/WH ~ Cc: Berkowitz, Avrahm J. EOP/WH ~ who.eop .gov> Subject: interoperability Jared , VA-18-0298-I-001174 Page 1899 of ~ 11/aof 1380 I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Techno logy Department of Veterans Affairs VA-18-0298-I-001175 Page 1900 of t17~ of 1380 Document ID: 0.7.1705.1489535 From: I(b_)(_6)_____ _ To: 011rnba11ldCassidv ~~- EOP/WHO l(b)(G) ®who.eop .gov> Berkowitz, Avrahm J. EOP/WHO Cc: ,....l (b-)(-6)---. @who .eop .gov> ; Blackburn , Scott R. Bee: Subject: RE: interoperability Date: Mon Mar 05 2018 12:05:16 EST Attachments: ~1 Hi Cassidy , would it be possible for Mr. Kushner to call Scott after 3:30PM EST ? He will be wrapp ing up speaking at HIMSS before that and may be still taking audience questions at 3PM. Thank s so much! l(b)(6) I Moblie :._l (b_)(G _)___ _. From: Dumbauld , Cassidy M.EOP/WHO l._ (b_)(6 _l _______ Sent: Monday, March 05 , 2018 8:29 AM To: Blackburn, Scott R. Cc : Berkowitz, Avrahm J. EOP/WHO ;I.... (b_J(_sJ_____ Subject: [EXTERNAL] RE : interoperability ___,@who .eop .gov] ____, Great he will speak with you soon! From: Blackburn, Scott R. (mailto :Scott.Blackburn@va.gov] Sent: Monday, March 5, 2018 11 :14 AM To: Dumbauld , Cassidy M. EOP/WHO ,.... !{b -l/-61 ------~ ta>who.eop.qov> Cc: Berkowitz, Avrahm J. EOP/WH ~ who.eop .gov>; l(b)(6) l(b)(6) @va .gov> ....___________ _. 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. VA-18-0298-I-001176 Page 1901 of ~ 1'%of 1380 5 From: Dumbauld, Cassidy M. EOP/WHO ..... l(b_)(_l________ Sent: Monday, March 05 , 2018 10:55 AM To: Blackburn, Scott R. 6 )_____ (b,,... )(_ Cc: Berkowitz, Avrahm J. EOP/WHO; l...,, Subject: [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? Hi Cassidy, 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: Dumbauld , Cassidy M. EOP/WHo ..... 1(b_J(_6 l________ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. l(b_)(_6 l_____ ___, Cc: Berkowitz, Avrahm J. EOP/WHO ;.... Subject: [EXTERNAL] RE: interoperability ~ @who .eop.gov] Hi Scott, VA-18-0298-I-001177 Page 1902 of ~ of 1117 1380 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 (b)(6 who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO( b)(6) who.eop .gov>; Liddell, Christopher P. EOP/WHO l{b)(6) @who.eop.gov> ; l(b)(6) Subject: RE : interoperability I Great. We will find time . From: Kushner , Jared C. EOP/W HO l(b)(6) l@who.eop.gov] Sent: Wednesday , February 28, 2018 7:56 AM To : Blackburn, Scott R. Cc: Berkowitz , Avrahm J. EOP/WHO; Liddell , Chr istopher P. EOP/WHO Subject: [EXTERNAL] RE : interoperability Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To : Kushner , Jared C. EOP/WHO (b)(6) who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shu lkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott Scott Blackburn VA-18-0298-I-001178 Page 1903 of ~ 11/sof 1380 Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001179 Page 1904 of t17~of 1380 Document ID: 0.7.1705.1489364 From: Dumbauld , Cassidy M. EOP/WHO j(b)(G) @who.eop.gov> To: Blackburn, Scott R. ~ kowitz, Avrahm J. EOP/WHO Cc: ~ who .eop.gov>; l(b)(6) r 1o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> 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 ,--------._ To: Dumbauld, Cassidy M. EOP/WHO b 6) who .eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>; j(b)(G) !(b)(G) @va .gov> .____________ __. 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 . From: Dumbauld , Cassidy M. EOP/WHo -l(b_)(_Gl________ Sent: Monday, March 05, 2018 10:55 AM To: Blackburn, Scott R. 6)_____ (b_)(_ __, Cc: Berkowitz, Avrahm J. EOP/WHO ; 1..,.., Subject: [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] VA-18-0298-I-001180 Page 1905 of ~11iof 1380 Hi Cassidy, 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 From: Dumbauld , Cassidy M. EOP/WHO ~j (b_)(_ G)_______ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. (b_)(_G)_____ Cc: Berkowitz, Avrahm J. EOP/WHO ;~l Subject: [EXTERNAL] RE: interoperability ~ t§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. [mai lto :Scott.Blackburn@va.gov] Sent: Wednesday, February 28, 2018 9:15 PM who.eop .gov> To: Kushner, Jared C. EOP/WHO b 6 Cc: Berkowitz, Avrahm J. EOP/WH (b)( ) who.eop .gov>; Liddell, Christopher P. EOP/WHO l(b)(G) @who.eop.gov> ; !{b)(G) Subject: RE: interoperability I Great. We will find time. VA-18-0298-I-001181 Page 1906 of ~ 11~of 1380 From: Kushner , Jared C. EOP/WHO l(b)(G) @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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto :Scott.Blackb urn@va .gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner, Jared C. EOP/WHO ~ @who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH ~ who.eop .gov> Subject: interoperability Jared , I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week. Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001182 Page 1907 of ~ 11~of 1380 Document ID: 0.7.1705.1763541 From: Blackburn , Scott R. To: Dumbauld, Cassidy M. EOP/WHO l(b)(6) t?v,who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO !/bl/6) @who.eop .gov>; l(b)(6) 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. 6)_________ (b_)(_ From: Dumbauld, Cassidy M. EOP/WHO l.._ Sent: Monday , March 05, 2018 10:55 AM To: Blackburn , Scott R. (b_)(_ G)_____ ~ Cc: Berkowitz, Avrahm J. EOP/WHO J~ Subject: [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 To: Dumbauld , Cassidy M. EOP/WH~"' ; (i.:::.b; )(6:)~=-~=-=-=-=-=-=-=-~~;';..u..,_==='-'--'----------, Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) l(b)(6) l@va.gov> Subject: RE: interoperability Hi Cassidy, 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-I-001183 Page 1908 of ~ 11~of 1380 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: Dumbauld , Cassidy M. EOP/WHO .... l(b_)(_6)_______ Sent: Sunday, March 04, 2018 11 :30 AM To : Blackburn, Scott R. 6)_____ Cc: Berkowitz, Avrahm J. EOP/WHO J,_ ~b -)(_ 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/WHO ~ who.eop.gov> Cc: Berkowitz , Avrahm J. EOP/WHO( b)/6) who.eo . ov>· Liddell Christo her P. EOP/WHO 6)_______________ l(b)(6) l@who.eop.gov>; ....._ (_ __, Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO l(b)(6) @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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] VA-18-0298-I-001184 Page 1909 of ~11iof 1380 Sent: Monday, February 26, 2018 5:05 PM To: Kushner, Jared C. EOP/WH (b)(6) who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop.gov> Subject: interoperability Jared , I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001185 Page 19 10 of ~ 11~of 1380 Document ID: 0.7.1705.484828 From: Blackburn, Scott R. To: Dumbauld , Cassid y M. EOP/WHO l(b)(6) @who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO l(b)(6) @who .eop. gov> ;l~ (b_)(_ 6)--,------,--.,........,...-~ Bee: Subject: RE: interoperability Date: Mon Mar 05 2018 11 :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. 6)_________ From : Dumbauld , Cassidy M. EOP/WHO l~ (b_)(_ Sent Monday , March 05, 2018 10:55 AM To : Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ; l..._ (b.._. )(6 ....;. )_____ ____, Subject: [EXTERNAL] RE: interoperability @-=who .eop.gov] Scott - Jared arrives around 10pm tonight so it might be better to have call. Would anyt ime between 3 and 5 work? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] _______ ~ Sent: Sunday , March 4 , 2018 11 :35 AM 6 To : Dumbauld , Cassidy M. EOP/WHQ( b)( ) who .eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>;( b)(6) l(b)(6l @va .gov> .____________ __. Subject: RE: interoperability Hi Cassidy, VA-18-0298-I-001186 Page 1911 of ~11iof 1380 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 6 From: Dumbauld , Cassidy M.EOP/WH q.~(b_)(_)________ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. (b-)(_6)______ Cc: Berkowitz, Avrahm J. EOP/WHO; ...,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? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va.gov] Sent: Wednesday , February 28, 2018 9:15 PM To: Kushner, Jared C. EOP/WHO (b)(6l who.eop.gov > Cc: Berkowitz, Avrahm J . EOP/WH (b)(6) who .eo . ov>; Liddell, Christo her P. EOP/WHO l(b)(6) @who.eop .gov> ; (b)(6) va.gov > Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO l(b)(6) l@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 Yes - perhaps we can schedule for next week or the week after since I am travelling? VA-18-0298-I-001187 Page 19 12 of ~ 11~of 1380 From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26 , 2018 5:05 PM To: Kushner, Jared C. EOP/WHO (b)(6 who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-001188 Page 19 13 of ~11iof 1380 Document ID: 0.7.1705.1489325 From: DumbauldCassjdy EOP/WHO l(b)(6) _@who.eop.gov> Blackburn, Scott R. Cc: ~ kowitz, Avrahm J. EOP/WHO ~ who .eop.gov>; l(b)(6) ~/o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: [EXTERNAL] RE: interoperability Date: Mon Mar 05 2018 10:55:04 EST Attachments: ¥· Scott - Jared arrives around 10pm ton ight so it might be better to have call. Would anyt ime between 3 and 5 work? Hi Cassidy , 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 From: Dumbauld , Cassidy M.EOP/WHo ._l (b_)(_l_______ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. 5 Cc: Berkowitz, Avrahm J. EOP/WHO; I,_ (b-)(_l_____ __.l@who .eop.gov] __. VA-18-0298-I-001189 Page 1914 of ~11iof 1380 Subject: [EXTE RNAL] 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( b) 6 ho.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(G) who.eop .gov>; Liddell, Christopher P. EOP/WHO l(b)(G) @who.eop.gov> ; l(b)(G) l@va.gov> Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO l(b)(6 ) l@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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday , February 26, 2018 5:05 PM To : Kushner, Jared C. EOP/WHO (b)(G who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO (b)(G) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week. VA-18-0298-I-001190 Page 1915 of ~11iof 1380 Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-001191 Page 1916 of t19~of 1380 Document ID: 0.7.1705.484798 From: D11mba11ldCass idv M. EOP/W HO l(b)(G) ~ who .eop.gov> To: Blac kburn, Scott R. Berkowitz, Avrahm J. EOP/W HO Cc: ,_l (b-)(6 - )---.@who .eop. gov> ;,.,_l (b..:..: )("""' 6)_____ ____. Bee: [EXTERNAL] RE: interoperability Subject: Mon Mar 05 2018 10:55:04 EST Date: Attachments: 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: Sunday , March 4, 2018 11 :35 AM __________ ~ To: Dumbauld, Cassidy M. EOP/WHO( b)(6) who .eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov>; (b)(6) l(b)(6) l@va .gov> ~----------~ Subject: RE: interoperability Hi Cassidy , I can make that time wo rk if we do a phone ca ll. 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 cou ld also do it there. Let me know. Scott (202) 430-9139 From: Dumbau ld, Cassidy M. EOP/WHO l._ (b_)(_ G)________ Sent: Sunday , March 04, 20 18 11 :30 AM To: Blackbu rn, Scott R. _.. b who.eop.gov ] VA-18-0298-I-001192 Page 1917 of ~ 11~of 1380 5 Cc: Berkowitz, Avrahm J. EOP/WHO ]~ ~-b)(_l_____ 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 (6 £12..ltil.b..O...e.otD....Ct.mL~.J.d..(1eJ..1 _L n.tllitOJ:i.n.E tL.1::~ Cc: Berkowitz, A vra h m J . EOP/WHO (b)~ l(b)(6) @who.eop.gov> ;L.. (b_)(_6l_____________ __,_ va.gov> Subject: RE : interoperability LJ ) Great. We will find time . From: Kushner , Jared C. EOP/WHO i(b)(6) l@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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va .gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner, Jared C. EOP/WHO (b)(6) who.eop .gov> Cc: Berkowitz, Avrahm J . EOP/WH (b)(6) who .eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week . VA-18-0298-I-001193 Page 19 18 of ~ 11~of 1380 Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-001194 Page 1919 of t19~of 1380 Document ID: 0.7.1705.1763070 From: Blackburn , Scott R. To: Dumbauld , Cassidy M. EOP/WHO j(b)(G) @who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO l(b)(G) @who .eop .gov> ;l(b)(6) f /o=va/ou=exchange administrative group (fydibohf23spdlt)/cn=recipients/cn=vacocallae2> Bee: Subject: RE: interoperability Date: Sun Mar 04 2018 11 :34:52 EST Attachments: Hi Cassidy , 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 (b_)(_l________ From: Dumbauld , Cassidy M.EOP/WHO ._l Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO ;i._ (b_)(_G)______ 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/WHO (b) 6 who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(G) who.eo . ov>; Liddell, Christo her P. EOP/WHO j(b)(G) @who .eop .gov> (b)(G) va.gov> VA-18-0298-I-001195 Page 1920 of ~ 11~of 1380 Subject: RE: interoperability Great. We will find time . From: Kushner, Jared C. EOP/WH O!(b)(6) @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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner, Jared C. EOP/WHO (b )(6 > who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop.gov > Subject: interoperabi lity Jared , I just spoke to Secretary Shu lkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001196 Page 192 1 of ~11iof 1380 Document ID: 0.7.1705.482698 From: Blackburn, Scott R. To: Dumbauld , Cassidy M. EOP/WHO l(b)(6) @who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WHO l{b)(6) @who .eop.gov> L..! (b..;._ )(--' 6)______ __. Bee: RE: interoperability Subject: Sun Mar 04 2018 11 :34:52 EST Date: Attachments: Hi Cassidy , 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 (b_)(_ G)________ From: Dumbauld , Cassidy M. EOP/WHO l._ Sent: Sunday , March 04, 2018 11 :30 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WH q (b)(G) Subject: [EXTERNAL] RE: interopera.... b-,1~ ,ty------~ __,__,@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 (b) 6 who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop.gov>; Liddell, Christopher P. EOP/WHO VA-18-0298-I-001197 Page 1923 of ~ 11~of 1380 6 l(b)(6) @who.eop.gov>; ._l (b_)(_l_____________ Subject: RE: interoperability ~va.gov> Great. We will find time. From: Kushner, Jared C. EOP/WHO l(b)(6) @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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner , Jared C. EOP/WHO (b)(6 who.eop.gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001198 Page 1924 of ~11iof 1380 Document ID: 0.7.1705.1487281 From: Dumbauld , Cassidy M. EOP/WHO l(b)(6) @who.eop.gov> To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO l(b)(6) @who .eop.gov> ~(b)(6) j Bee: Subject: [EXTERNAL] RE: interoperability 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, 2018 9:15 PM To: Kushner, Jared C. EOP/WHO (b)(6 who.eop .gov> Cc: Berkowitz , Avrahm J. EOP/WH '1.: (:.:..:.b l..:..:: (6.:_ ) ~=o!..u<.l~=~.!a.!.l,d=~==~!o<.!....J............i,EOP/WHO @who.eop.gov> ; )(6) va.gov> l(b)(6) Subject: RE: interoperability Great. We will find time . From: Kushner , Jared C. EOP/WHO ~b)(6) @who.eop .gov] Sent: Wednesday, February 28, 20 1 7:56 AM To: Blackburn, Scott R. Cc: Berkowitz, Avrahm J. EOP/WHO; Liddell , Christopher P. EOP/WHO Subject: [EXTERNAL] RE: interoperability Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto :Scott.Blackburn@va .gov] Sent: Monday, February 26, 2018 5:05 PM VA-18-0298-I-001199 Page 1926 of ~11iof 1380 To: Kushner, Jared C. EOP/WHO (b)(6) who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov> Subject: interope rabi lity Jared, I just spoke to Secretary Shu lkin and he ment ioned you are look ing for an update on where we are with interoperab ility. If so, let me know and I'll make t ime this week . Scott Scott Blackburn Acting C IO & Executive-in-Charge, Office of Informat ion & Technology Department of Veterans Affairs VA-18-0298-I-001200 Page 1927 of ~~biof 1380 Document ID: 0.7.1705.482695 From: D11rnba1 !Id Cass idv EOP/W HO j(b)(6) J@who .eop.gov> Blackburn, Scott R. ~..... Bu.ie...,r kowitz, Avrahm J. EOP/W HO Cc: l(b)(G) @who .eop.gov> j~ (b-)(6 - )------~I ¥· Bee: Subject: Date: Attachments: [EXTERNAL] RE: interoperability Sun Mar 04 20 18 11 :30:23 EST 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 (b)(6 who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/WHO (b)(6) who.eo . ov>; Liddell, Christo her P. EOP/WHO l(b)(6) @who.eop .gov> ; (b)(6) va.gov> Subject: RE: interoperability Great. We will find time . l@who.eop .gov] From: Kushner, Jared C. EOP/W HO l(b)(6) 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: [EXTERNA L] RE: interoperability Yes - perhaps we can schedule for next week or the week after since I am trave lling? From: Blackburn, Scott R. (mailto:Scott.Blackburn@va .gov] VA-18-0298-I-001201 Page 1928 of ~~b~ of 1380 Document ID: 0.7.1705.478283 From: Blackburn, Scott R. !lb\16\ l; Windom, John H. Cc: Bee: Subject: FW: interoperability Date: Wed Feb 28 2018 21:15:40 EST Attachments: Lets discuss briefly tomorrow. @who.eop .gov] From: Kushner, Jared C. EOP/WHO !(b)(6) 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 Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday, February 26, 2018 5:05 PM To: Kushner , Jared C. EOP/WHO (b)(6l who.eop .gov> Cc: Berkowitz, Avrahm J. EOP/W (b)(6) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability . If so, let me know and I'll make time this week . Scott Scott Blackburn VA-18-0298-I-001202 Page 1930 of ~~b~ of 1380 Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001203 Page 1931 of t~O~ of 1380 Scott Blackburn Acting C IO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001204 Page 1933 of t~O~ of 1380 Document ID: 0.7.1705.478730 Blackburn, Scott R. Kushner, Jared C. EOP/WHO To: ~ who.eop .gov> Cc: .-- - B'-"""-i rkowitz, Avrahm J. EOP/WHO (b)(6) >· Liddell, Christopher P. EOP/WHO (b_)(_6)_____ ____. (b)(6) who. eop. gov> ;._l Cc: Berkowitz, Avrahm J. EOP/WH (b)(6) who.eop .gov> Subject: interoperabi lity Jared, I just spoke to Secretary Shu lkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott VA-18-0298-I-001205 Page 1934 of ~~b~ of 1380 Document ID: 0.7.1705.478717 From: Blackburn, Scott R. Windom, John H. ; Short, John (VACO) ; Zenooz , Ashwini Cc: Bee: FW: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Feb 28 2018 21 :08:07 EST Date: Attachments: From: Bruce Moskowitz l(b)(6) l@mac.com] Sent: Wednesday , February 28, 2018 4:53 PM To: Blackburn, Scott R. Cc: DJS ; Marc Sherman; O'Rourke, Peter M.; IP;l(b)(6) @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-I-001206 Page 1936 of ~~biof 1380 flowsheet. When outside labs are mapped we wou ld 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 dup lication , over utilization and medication dup lication/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 interact ions 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' Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(6) @gmail.com 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-I-001207 Page 1937 of ~~b~ of 1380 From: Bruce Moskowitz l(b)(6) @mac.com] Sent: Wednesday , February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(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: 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-I-001208 Page 1938 of ~~biof 1380 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)(6) Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: l(b)(6) @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. 6l_____ (b_)(_ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ._l _.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_)(_6)_____ 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 VA-18-0298-I-001209 Page 1939 of ~~biof 1380 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 somet hing, 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 Innovation s. #3) Below is the IP lanauaae that we neaotiated. I l(b)(5) (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-I-001210 Page 1940 of ~~~i of 1380 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-I-001211 Page 1941 of t~Wof 1380 Concur with Cerner edit, negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001212 Page 1942 of t~rn of 1380 Document ID: 0.7.1705.478101 From: Bruce Moskowitz l(b)(6l @mac.com> Blackburn, Scott R. DJS ; Marc Sherman l(b)(6) @gmail.com>; O'Rourke, Peter M. ; IP(b)(6 frenchangel59.com>; gmail.com> l(b)(6) @gmail.com b 6 Bee: Re: [EXTERNA L] Re: Open API - it is CLOUD+ languge + Rasu Subject: Wed Feb 28 2018 16:53:27 EST Date: Attachments: 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-I-001213 Page 1943 of ~~~~ of 1380 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' @gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(b)(6) 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(b)(6) l@mac.com] Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP: l(b)(6) @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-I-001214 Page 1944 of ~~~i of 1380 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-I-001215 Page 194 5 of t~rn of 1380 Scott @mac.com] From: Bruce Moskowitz !(b)(6) Sent: Tuesday , February 27, 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP; l(b)(6) @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. 6)______ l(b_)(_ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ..... @ma c.co m> 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(b_)(_6)_____ 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: VA-18-0298-I-001216 Page 1946 of ~~~i of 1380 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. l(b)( 5 ) 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: VA-18-0298-I-001217 Page 1947 of ~~~~ of 1380 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-I-001218 Page 1948 of t~rn of 1380 -Scott VA-18-0298-I-001219 Page 1949 of t~rn of 1380 Document ID: 0.7.1705.380899 From: Bruce Moskowitz @mac.com> l(b)(6) To: Blackburn, Scott R. Cc: DJS ; Marc Sherman !(b)(6) @gmail.com>; O'Rourke, Peter M. ; IP b 6 frenchangel59.com> j(b)(6) @gmail.com (b)(6) gmail.com> Bee: Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Date: Wed Feb 28 2018 16:53:27 EST Attachments : Thank you progress is being made but as my group keeps saying dev il 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 addre ss 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-I-001220 Page 1950 of ~~1i of 1380 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' @gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP:l(b)(6) 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(b)(6) @mac.com] Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. l@.gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(b)(G) Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-I-001221 Page 1951 of ~~1~ of 1380 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-I-001222 Page 1952 of t~2~of 1380 Scott From: Bruce Moskowitz l(b)(6) @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)(6) @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. 6l_____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ._l (b_)(_ ___,...,@ma c.co m> 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. 6)_____ On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ..... l(b~)(~ ~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-I-001223 Page 1953 of ~~1~ of 1380 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 l(b)(5) (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-I-001224 Page 1954 of ~~1i of 1380 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-I-001225 Page 195 5 of t~2~of 1380 -Scott VA-18-0298-I-001226 Page 1956 of t~2~of 1380 Document ID: 0.7.1705.1761558 From: Blackburn, Scott R. To: Bruce Moskowitz l(b)(6) @mac .com> DJS ; Marc Sherman !ib}/6} @gmail.com>; O'Rourke, Peter M. ; IP ~!i b-}/6 --}~ @frenchangel59.com>; l(b)(6) @gmail.com !/b)/6) @gmail.com> Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu 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-I-001227 Page 1957 of ~~1~ of 1380 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)(G) 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(b)(6) @mac.com] Sent: Wednesday , February 28, 20181 :13 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP;l(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-I-001228 Page 1958 of ~~1i of 1380 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 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-I-001229 Page 1959 of t~2~of 1380 From: Bruce Moskowitz l(b)(6) @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)(6) @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-'-' )('--' 6)_____ __J@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_)(_ 6)_____ ~ @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-I-001230 Page 1960 of ~~\iof 1380 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(b)(S) (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-I-001231 Page 1961 of ~~\~ of 1380 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-I-001232 Page 196 2 of t~~~ of 1380 8-0298-I-001233 Page 1963 mg of 1330 Document ID: 0.7.1705.478092 From: Blackburn, Scott R. To: Bruce Moskowitz l(b)(6l l@mac .com> DJS ; Marc Sherman !lbl/Gl @gmail.com>; O'Rourke, Peter M. ; I Cb)C5) frenchangel59.com>; l(b)( 6 ) _@gmail.com (b)(6) 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 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 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-I-001234 Page 1964 of ~~\iof 1380 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)(6) 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 Kb)(6) l@mac.com] Sent: Wednesday , February 28, 20181 :13 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP;l(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-I-001235 Page 1965 of ~~\~ of 1380 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-I-001236 Page 1966 of t~~~ of 1380 From: Bruce Moskowitz l(b)(6) @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)(6) @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_)(_6)_____ __,@mac.com> wrote: To clarify further it states their commercial cloud instead a commercial cloud Open to all entities and of equal importanc e an open platform to all not ju st amazon but to all Working on Sent from my iPad Bruce Moskowit z M.D . On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ._l (b_)(_6)_____ _, @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 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 VA-18-0298-I-001237 Page 196 7 of ~~\~ of 1380 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. I #3) Below is the IP language that we negotiated .i(b)(5 ) (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-I-001238 Page 1968 of ~~\iof 1380 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-I-001239 Page 1969 of t~~~ of 1380 8-0298-I-001240 Page 1970 ?f @113 of 1380 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-I-001241 Page 1971 of t~l~of 1380 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. From: Bruce Moskowitz l(b)( 6 ) @mac.com] Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. l@gmail.com Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP: l(b)(6) 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-I-001242 Page 1972 of ~~\~ of 1380 ******** 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)(6) Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn , Scott R. Cc: DJS ; Marc Sherman ; O'Rourke , Peter M. ; IP;l(b)(6) @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~)(~ 6)_____ 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-I-001243 Page 1973 of ~~\~ of 1380 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~)(~6 )~----~ @mac.com> 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 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 Hea lthCare Innovations. I #3) Below is the IP lanauaae that we neaotiated. l(b)(5 ) (b )( 5) VA-18-0298-I-001244 Page 1974 of ~~\iof 1380 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-I-001245 Page 1975 of t~l~of 1380 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-I-001246 Page 1976 of t~l~of 1380 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-I-001247 Page 1977 of t~l~ of 1380 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)(6) Sent: Wednesday, February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(6l @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-I-001248 Page 1978 of ~~\iof 1380 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)(6) @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(b)(6) i@gma il.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_)(_6)_____ On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l ~ t@mac.co m> wrote: VA-18-0298-I-001249 Page 1979 of ~~\iof 1380 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_)(_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: #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 lanQuaQethat we neQotiated. l(b)(5 ) (b)(5) VA-18-0298-I-001250 Page 1980 of ~~Ye of 1380 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." VA-18-0298-I-001251 Page 1981 of t~$~ of 1380 Suggest VA obtain a price from the Contractor to provide a report explain the steps involved in accessing the data model, including producing an example data file, and demonstrating how much of the data is computable; provide cost estimates for outside parties to access the data via this mechanism. Cerner Concur , with requested change: Suggest adding to Section 5.10.4.1: "n) The Contractor shall support Knowledge Interoperability by supporting the extension of clinical content assets such as terminologies, clinical decision support rules , order sets , etc., to the extent such extensions are consistent with the model and best practices of the controlling national standard. This includes the ability to curate, extend , and share that knowledge with clinical partners. This fosters rapid adoption from industry best practices, e.g., clinical professional societies. " Concur with Cerner edit , negotiated inclusion at no additional cost. Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001252 Page 198 2 of t~$~ of 1380 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 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. @ma c.com ] From: Bruce Moskowitz l(b)(6) Sent: Wednesday, February 28, 2018 1:13 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP; l(b)(6) VA-18-0298-I-001253 Page 1983 of ~~~ of 1380 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-I-001254 Page 1984 of t~$~ of 1380 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 From : Bruce Moskowitz l(b)( 6 ) @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)( 6) 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. l (b)(6) 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. VA-18-0298-I-001255 Page 198 5 of ~~Ys of 1380 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_)(_6 )_____ __.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)(S) (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-I-001256 Page 1986 of ~~~ of 1380 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-I-001257 Page 1987 of t~$~ of 1380 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-I-001258 Page 1988 of t~$~ of 1380 Document ID: 0.7.1705.478019 From: Short, John (VACO) To: Blackburn, Scott R. Windom , John H. Cc: ; Zenooz, Ashwini Bee: RE: Open AP I - 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 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. (b_)(_6l________ From: Bruce Moskowitz ~l @mac .com] VA-18-0298-I-001259 Page 1989 of ~~~ of 1380 Sent: Wednesday, February 28, 20181:13 PM To: Blackburn, Scott R. l@gmail.com Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP:l(b)(6 ) 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-I-001260 Page 1990 of ~~1i of 1380 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(b)(6) 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)(6) 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. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz -l(b_)(_6l_____ ~ @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 VA-18-0298-I-001261 Page 1991 of ~~1~ of 1380 Bruce Moskowitz M.D. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz ~!(b_)(_6)_____ ~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)(5 ) (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-I-001262 Page 1992 of ~~1~ of 1380 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-I-001263 Page 1993 of t~e~ of 1380 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-I-001264 Page 1994 of t~e~ of 1380 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!!! From: Bruce Moskowitz l(b)(6) @mac.com] Sent: Wednesday , February 28, 20 18 2:56 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(6) @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-I-001265 Page 1995 of ~~1~ of 1380 From: Bruce Moskowitz l(b)(G) @mac.com] Sent: Wednesday, February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(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 : 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 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-I-001266 Page 1996 of ~~1i of 1380 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)(6) @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)(6) @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. On Feb 27, 2018 , at 9:20 PM, Bruce Moskowitz ._l (b_)(_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. VA-18-0298-I-001267 Page 1997 of ~~1~ of 1380 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_)(_6)_____ ___. @,_,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 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 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(b)(5) (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 VA-18-0298-I-001268 Page 1998 of ~~1i of 1380 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 languag e 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, 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 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 explain 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 Interoperabili ty by VA-18-0298-I-001269 Page 1999 of t~e~ of 1380 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-I-001270 Page 2000 of t~f~ of 1380 Document ID: 0.7.1705.807828 From: Bruce Moskowitz l(b)(6) @mac .com> To: Blackburn , Scott R. Cc: DJS ; Marc Sherman (b)(6) gmail.com>; O'Rourke, Peter M. ; IP ~l (b-)(6...... ) ,._, l@,frenchangel59.com>; l(b)(6) @gmail.com l(b)(6) @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 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(b)(6) Sent: Wednesday , February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP;l(b)(6) @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-I-001271 Page 2001 of ~~1A of 1380 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-I-001272 Page 2002 of t~f~ of 1380 Scott From: Bruce Moskowitz l(b)(G) @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)(6) @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_)(_6l_____ _. @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_)(_6l_____ ~ @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-I-001273 Page 2003 of ~~~ of 1380 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 language that we negotiated. l(b)(5) (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, tha t 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-I-001274 Page 2004 of ~~1/a of 1380 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-I-001275 Page 200 5 of t~f~ of 1380 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001276 Page 2006 of t~f~ of 1380 Document ID: 0.7.1705.478007 From: Bruce Moskowitz l(b)(6) @mac.com> To: Blackburn, Scott R. Cc: DJS ; Marc Sherman l(b)(6) @gmail.com>; O'Rourke, Peter M. ; IP(b)(6 frenchangel59.com>; l(b)(6) !@gmail.com (b)(6) 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 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 From: Bruce Moskowitz l(b)(6) l@mac.com] Sent: Wednesday , February 28, 20181:13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke, Peter M.; IP:l(b)(6) @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu VA-18-0298-I-001277 Page 2007 of ~~1/7 of 1380 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 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-I-001278 Page 2008 of t~f~ of 1380 Scott From: Bruce Moskowitz l(b)(6) @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)(6) 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_)(_6l_____ __.@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_)(_6)_____ __.@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-I-001279 Page 2009 of ~~Wi of 1380 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 language that we negotiated. l(b)(5 ) (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-I-001280 Page 20 10 of ~~1iof 1380 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-I-001281 Page 20 11 of t~S~ of 1380 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001282 Page 2012 of t~S~ of 1380 Document ID: 0.7.1705.1200897 From: Short, John (VACO) To: Blackburn, Scott R. Cc: 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 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. From: Bruce Moskowitzl(b)(6) l@mac.com ] Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. l@gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; 1p j(b)(G) 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-I-001283 Page 2013 of ~~1~ of 1380 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-I-001284 Page 20 14 of t~S~ of 1380 From: Bruce Moskowitz l(b)(6) @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)(6) 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~)(~6)~ _____ @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_)(_ 6)_____ ~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-I-001285 Page 20 15 of ~~1~ of 1380 #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 l(b)(S) (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-I-001286 Page 20 16 of ~~1i of 1380 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-I-001287 Page 20 17 of t~S~ of 1380 VA-18-0298-I-001288 Page 2018 of t~S~ of 1380 Document ID: 0.7.1705.478006 From: Short, John (VACO) To: Blackburn, Scott R. Windom , John H. Cc: ; Zenooz, Ashwini Bee: RE: Open AP I - 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. l@mac.com] From: Bruce Moskowit ~(b)(6) Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(b)(6) @gmail.com Subject: Re: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Thank you my five C IO's had looked forward to tar and feathering me if the cloud is not done correctly! The other issues are: VA-18-0298-I-001289 Page 2019 of ~~1i of 1380 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-I-001290 Page 2020 of t~9~of 1380 Scott From: Bruce Moskowitz l(b)(6) @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)(6) 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 Moskow itz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz l._ (b~)(~ 6)_____ _.l@mac.com> wrote: To clarify further it states their commercia l cloud instead a comme rcial cloud Open to all entities and of equal importanc e an open platform to all not ju st 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_)(_ 6)_____ __, @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-I-001291 Page 202 1 of ~~1~ of 1380 #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 cooperation to acce lerate HealthCare Innovations. #3) (b)(5) Below is the IP lanquaqe that we neqotiated. I l(b)(S) Of importance : Third[MJT1] party AP I developers shall retain their IP rights when their AP I 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 digita l enterprise. A cornerstone of this effort is the setup of a strategic Open API Program, The Digital Veteran Platform AP I 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 parag raph 5.8(h) as highlighted at no additional cost: 49 VA-18-0298-I-001292 Page 2022 of ~~1~ of 1380 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-I-001293 Page 2023 of t~9~of 1380 -Scott VA-18-0298-I-001294 Page 2024 of t~9~of 1380 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. @mac.com] From: Bruce Moskowitz l(b)(6) Sent: Wednesday, February 28, 20 18 1 :13 PM To: Blackburn, Scott R. @gmail.com Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(b)(G) 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-I-001295 Page 2025 of ~~1~ of 1380 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 serv icemembers 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)(6) l@mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To : Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M. ; IP:I(?)(6) 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-I-001296 Page 2026 of ~~1iof 1380 Bruce Moskowitz M.D. (b~)(~6~ ) _____ 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. On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_)(_ 6)_____ __. @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 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-I-001297 Page 2027 of ~~1~ of 1380 I #3) Below is the IP lanQuaQethat we neQotiated. l(b )(S) (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 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-I-001298 Page 2028 of ~~1iof 1380 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-I-001299 Page 2029 of t~9~of 1380 Document ID: 0.7.1705.477899 Blackburn, Scott R. Bruce Moskowitz To: l(b)(6) @mac .com> Cc: DJS ; Marc Sherman ; O'Rourke, Peter M. ; l~ frenchangel59.com>; lperl2528@gmail.com !(b)/6) @gmail.com> Bee: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Subject: Wed Feb 28 2018 14:32:54 EST Date: Attachments: 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(b)(6l l@mac.com] Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman ; O'Rourke , Peter M.; IP; l(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: Voice Recognition All entering lab data on a graph from any source VA-18-0298-I-001300 Page 2030 of ~~biof 1380 Catching test duplication , over utilization and medication dup lication/er rors at time of ordering not afte r 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 incred ibly helpful. Thank you very much . I had my team dig into this this more this morning. What you have stated below is clea rly 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. Current ly 3 cloud providers meet the Government secu rity 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 standa rds are dictated by GSA, not VA). Cerner does have a partne rship with AWS (whic h 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 conf irmed 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 crysta l clear . Scott VA-18-0298-I-001301 Page 203 1 of t~O ~of 1380 From: Bruce Moskowitz l(b)(S) @mac.com] Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. 5 Cc: DJS; Marc Sherman; O'Rourke , Peter M.; 1pJ(b)( ) @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_)(_6l_____ __.@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 . 5 On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz .... l(b_)(_ 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-I-001302 Page 2032 of ~~b~ of 1380 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 (b_)(_ )_________ #3) Below is the IP language that we negotiated. ~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 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-I-001303 Page 2033 of ~~b~ of 1380 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-I-001304 Page 2034 of t~O~ of 1380 Page 2035 of 1380 Document ID: 0.7.1705.807821 From: Blackburn, Scott R. To: Bruce Moskowitz l(b)(6) l@mac .com> Cc: DJS ; Marc Sherman l(b)(6l @gmail.com>; O'Rourke, Peter M. ; IP ,-! lb-l/-6l~ @frencha ngel 59.com> ;j(b)(6) @gmai I.com l(b)(6) @gmail.com> Bee: Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Wed Feb 28 2018 14:32:54 EST Date: Attachments: 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@mac.com ] From: Bruce Moskowit ~(b)(6) Sent: Wednesday , February 28, 2018 1 :13 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP:l(b)(6) l@gma il.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 VA-18-0298-I-001306 Page 2036 of ~~biof 1380 Catching test dup lication , over util ization and medicat ion dup lication/er rors at time of ordering not afte r the fact Stream lined SOAP notes Sent from my iPad Bruce Moskow itz M.D. On Feb 28, 20 18, at 12:52 PM, Blackburn , Scott R. wrote: Bruce - this is incred ibly helpfu l. T hank you very much . I had my team dig into this this more this mo rning. What you have stated below is clea rly the intent (we need everything to be OPEN and absolutely do not want to inadverten tly create vendo r lock) ; we 've also gone back th is morn ign to confirm with Cerner t hat 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 Ama zon Web Services (AWS) . Rathe r any cloud provider or a pplications that meet security and privacy requirements to protect Veteran data can interface w ith Open APls or push data to the VA/Cerner system. ***** **** Currently 3 cloud providers meet the Government security requirements - AWS, Azure/M icrosoft 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 certa in standards (these standards are dictated by GSA , not VA) . ***** **** Cerner does have a partnersh ip with AWS (which is why we highlighted that) but it is j ust one examp le of the open cou ld environments they are planning to work with. We have conf irmed that it will be OPEN and not proprietary to the ir specific AWS cloud. ********* DoD is excited to fo llow our lead on all of this. I spent the morn ing at the Pentagon wit h the DoD CIO/team. Th is wi ll he lp not j ust Veterans , but servicemembe rs still in uniform. Thanks again for the feedback and support . We are going to make sure this is crysta l clear . Sco tt VA-18-0298-I-001307 Page 2037 of t~O~ of 1380 From: Bruce Moskowitz ~l (b_)(_6)___________ ~ Sent: Tuesday , February 27 , 2018 9:29 PM To: Blackburn, Scott R. Cc: DJS; Marc Sherman; O'Rourke , Peter M.; IP;l(b)(6) @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_)(_5 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 . 6l_____ On Feb 27, 2018 , at 8:20 PM, Bruce Moskowitz ~l (b_)(_ ~@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-I-001308 Page 2038 of ~~biof 1380 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. l(b)( 5 ) (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-I-001309 Page 2039 of ~~biof 1380 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-I-001310 Page 2040 of t~l~ of 1380 8-0298-I-001 311 Page 2041 of 1380 Document ID: 0.7.1705.807713 Bruce Moskowitz From: !(b)(6l @mac .com> To: Blackburn , Scott R. Cc: DJS ; Marc Sherman l(b)(6) l@gmail.com>; O'Rourke, Peter M. ; IP -l(b-)(-'6 )....:....... ~frencha ngel 59. com> ;l(b)(6) @gmai I.com ! 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 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. There are several others that we expect to come on board soon including VA-18-0298-I-001312 Page 2042 of~~~~ of 1380 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(b)(6) l@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)(6) @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 i~(b_)(_6)_____ ~ @mac.com> 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-I-001313 Page 2043 of~~~~ of 1380 Bruce Moskowitz M.D. 5 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 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 lanauaae that we neaotiated . l(b)(S) (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-I-001314 Page 2044 of ~~~i of 1380 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-I-001315 Page 204 5 of t~l~ of 1380 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-I-001316 Page 2046 of t~l~ of 1380 Document ID: 0.7.1705.477819 From: Bruce Moskowitz l(b)( 6 ) To: Cc: ~mac .com> Blackburn, Scott R. DJS ; Marc Sherman ...J:::,gmail.com>;O'Rourke, Peter M. ; I (bl< 6l frenchangel59.com>; !/bl}6l @gmail.com (b)(6) gmail.com> L....:,.;,__;_ Bee: Subject: Date: Attachments : ___ Re: [EXTERNAL] Re: Open API - it is CLOUD+ languge + Rasu Wed Feb 28 2018 13:13:19 EST 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 /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 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 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. There are several others that we expect to come on board soon including Google and VA-18-0298-I-001317 Page 2047 of~~~~ of 1380 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 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 Moskowit~( b)(6) @mac.com] Sent: Tuesday , February 27, 2018 9:29 PM To : Blackburn, Scott R. l@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. 6 On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz ~l (b_J(_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 VA-18-0298-I-001318 Page 2048 of ~~~i of 1380 Bruce Moskowitz M.D. 6 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_)(_ )_____ __.@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 lanauaae that we neaotiated. l(b)(5 ) (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their AP I 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-I-001319 Page 2049 of ~~~i of 1380 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-I-001320 Page 2050 of t~2~of 1380 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-I-001321 Page 205 1 of t~2~of 1380 Document ID: 0.7.1705.1761200 Blackburn , Scott R. Bn ice Moskowitz To: l(b)(G) @mac.com> DJS ; Marc Sherman l(b)(6) @ gma il.com>; O'Rourke, Peter M. ; IP (b)(6) frenchange l59.com>; l(b)(6) @gma il.com (b)(6) gmail.com> Bee: RE: [EXTERNAL] Re: Open AP I - 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 crea te 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 application s 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 Governmen t sec urity 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 provi der meets certain standards (these sta ndards are dictated by GSA, not VA). ********* Gerner does have a partnership with AWS (which is why we highlighted that) but it is j ust one examp le of the open cou ld env iro nments they are planning to work with. We have conf irmed 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 Vete rans, but servicemembers still in uniform. Thanks again for the feedback and support. We are going to make sure this is crysta l clear. Scott VA-18-0298-I-001322 Page 2052 of ~~1~ of 1380 From: Bruce Moskowitz l(b)(S) @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)( 6 ) 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 ~._ (b_)(6 _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. 5 On Feb 27, 2018, at 8:20 PM, Bruce Moskowitz .... l(b_)(_ 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 VA-18-0298-I-001323 Page 2053 of ~~1~ of 1380 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 lanauaae that we neaotiated. l(b)(S) (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-I-001324 Page 2054 of ~~1iof 1380 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-I-001325 Page 205 5 of t~2~of 1380 VA-18-0298-I-001326 Page 2056 of t~2~of 1380 Document ID: 0.7.1705.477552 Blackburn, Scott R. Bn ice Moskowitz To: l(b)(G) l@mac .com> Cc: DJS ; Marc Sherman ; O'Rourke, Peter M. ; I (b)(6 frenchangel59.com>; l(b)(G) ~gm ail.com (b)(6) gmail.com> Bee: Subject: RE: [EXTERNAL] Re: Open AP I - 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 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 Serv ices (AWS) . Rather any cloud provider or applicat ions that meet security and privacy requirements to protect Veteran data can interface with Open APls or push data to the VA/Gerner system. Current ly 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. Aga in, the goal here is to create open environment as long as the provider meets certain standards (these standa rds are dictated by GSA, not VA). Gerner does have a partnership with AWS (whic h 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 conf irmed 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. Th is 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 crysta l clear. Scott VA-18-0298-I-001327 Page 2057 of ~~1~ of 1380 From: Bruce Moskowi d (b)(G) @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)(6) 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. 6)_____ l(b_)(_ 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_)(_5)______ On Feb 27, 2018, at 8:20 PM, Bruce Moskowid .... -=@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 VA-18-0298-I-001328 Page 2058 of ~~1i of 1380 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)(5 ) (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-I-001329 Page 2059 of ~~1iof 1380 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-I-001330 Page 2060 of t~1~ of 1380 VA-18-0298-I-001331 Page 2061 of t~:!~ of 1380 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-I-001332 Page 2062 of t~:!~ of 1380 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-I-001333 Page 2063 of t~:!~ of 1380 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? Sent with Good (www.good .com) VA-18-0298-I-001334 Page 2064 of t~:!~ of 1380 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) (b)(5) Below is the IP lanauaae that we neaotiated . l(b)(S) VA-18-0298-I-001335 Page 206 5 of ~~\~ of 1380 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-I-001336 Page 2066 of t~1~ of 1380 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-I-001337 Page 2067 of t~:!~ of 1380 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 application and from any cloud environment that meets the requisite security and privacy requirements to protect Veteran data . Also , there have been public 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-I-001338 Page 2068 of t~1~ of 1380 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-I-001339 Page 2069 of t~:!~ of 1380 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-I-001340 Page 2070 of t~l~of 1380 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 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 coope ration to accelerate HealthCare Innovation s. #3) Below is the IP lanquaqe that we neqotiated . l(b)(S) (b)(S) 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-I-001341 Page 207 1 of ~~\~ of 1380 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-I-001342 Page 2072 of t~l~of 1380 Cerner 's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001343 Page 2073 of t~l~of 1380 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-I-001344 Page 2074 of t~l~of 1380 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-I-001345 Page 2075 of t~l~of 1380 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-I-001346 Page 2076 of t~l~of 1380 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 language that we negotiated. l(b)(S) (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 Interoperab ility Panel findings is as follows, Gerner agreed to suggested addition of PWS paragraph VA-18-0298-I-001347 Page 2077 of ~~\~ of 1380 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 terminologie s, 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, 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. 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-I-001348 Page 207 8 of t~l~of 1380 Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001349 Page 2079 of t~l~of 1380 Document ID: 0.7.1705.476959 ~ hner, Jared C. EOP/WHO From: ~ who.eop.gov> To: Blackburn, Scott R. Berkowitz, Avrahm J. EOP/WHO Cc: l(b-)(6 .- )......;...., !a)who eoo oov>kiddell , Christopher P. EOP/WHO l(b)(6) IQJWho.eop.gov> Bee: Subject: [EXTERNAL] RE: interoperability Date: Wed Feb 28 2018 07:56: 11 EST Attachments: Yes - perhaps we can schedule for next week or the week after since I am travelling? From: Blackburn, Scott R. [mailto:Scott.Blackburn@va.gov] Sent: Monday , February 26, 2018 5:05 PM To : Kushner , Jared C. EOP/WHO( b)(6) who.eop .gov > Cc: Berkowitz, Avrahm J. EOP/WHO( b)(6) who.eop .gov> Subject: interoperability Jared, I just spoke to Secretary Shulkin and he mentioned you are looking for an update on where we are with interoperability. If so, let me know and I'll make time this week . Scott Scott Blackburn Acting CIO & Executive-in-Charge, Office of Information & Technology Department of Veterans Affairs VA-18-0298-I-001350 Page 2080 of ~~Ye of 1380 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)(S) ~----~ 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-I-001351 Page 2081 of ~~~ of 1380 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-I-001352 Page 2082 of t~$~ of 1380 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-I-001353 Page 2083 of t~$~ of 1380 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(b)(S) (b)(S) 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-I-001354 Page 2084 of ~~Y}iof 1380 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-I-001355 Page 208 5 of t~$~ of 1380 Cerner's edits consistent with intent of recommendation . -Scott VA-18-0298-I-001356 Page 2086 of t~$~ of 1380 Document ID: 0.7.1705.476902 From: Blackburn, Scott R. To: Windom, John H. ; Short, John (VACO) Cc: Bee: Subject: RE: [EXTERNAL ] Re: Open API - it is CLOUD + languge + Rasu Date: Wed Feb 28 2018 06:04:04 EST Attachments: Ok Sent with Good (www.good.com) From: Windom , John H. Sent: Wednesday , February 28, 20 18 5:38:57 AM To: Short, John (VACO); Blackburn , Scott R. Subject: RE: [EXTERNAL] Re : Open API - it is CLOUD + languge + Rasu Sir None of what I read is hard. However, I cannot meet until after pentagon session. Metroing to the pentagon this morning . Vr John Sent with Good (www .good .com) From: Short , John (VACO) Sent: Tuesday , February 27 , 2018 7:04:56 PM To: Blackburn, Scott R.; Windom, John H. Subject: RE: [EXTERNAL] Re: Open API - it is CLOUD + languge + Rasu Roger that! VA-18-0298-I-001357 Page 2087 of t~$~ of 1380 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-I-001358 Page 2088 of t~S~ of 1380 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-I-001359 Page 2089 of t~$~ of 1380 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(b)(S) (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-I-001360 Page 2090 of ~~1i of 1380 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-I-001361 Page 2091 of t~e~of 1380 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-I-001362 Page 2092 of t~e~ of 1380 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-I-001363 Page 2093 of t~e~ of 1380 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-I-001364 Page 2094 of t~e~ of 1380 #3) Below is the IP language that we negotiated. l(b)(S) (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 AP I 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-I-001365 Page 2095 of ~~1~ of 1380 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 Interoperabili ty 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 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-I-001366 Page 2096 of t~e~ of 1380 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-I-001367 Page 2097 of t~e~ of 1380 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-I-001368 Page 2098 of t~e~ of 1380 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 . l (b)(5) #3) Below is the IP lanauaae that we neaotiated. (b)(5) Of importance: Third[MJT1] party API developers shall retain their IP rights when their API is used to VA-18-0298-I-001369 Page 2099 of ~~1i of 1380 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 the data is computable; provide cost estimates for outside parties to access the data via this mechanism. VA-18-0298-I-001370 Page 2 100 of t~f~ of 1380 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 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 Cerner edit, negotiated inclusion at no additional cost. Cerner 's edits cons istent with intent of recommendation . -Scott VA-18-0298-I-001371 Page 2101 of t~f~of 1380 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-I-001372 Page 2102 of t~f~ of 1380 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-I-001373 Page 2 103 of t~f~ of 1380 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 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)(5) (b)(5) VA-18-0298-I-001374 Page 2 104 of ~~1/a of 1380 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 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-I-001375 Page 2 105 of t~f~ of 1380 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-I-001376 Page 2106 of t~f~ of 1380 Document ID: 0.7.1705.476896 From: DJS To: Blackburn, Scott R. Cc: Bee: Subject: RE: [EXTERNAL] Re: Open AP I - it is CLOUD + languge + Rasu Date: Tue Feb 27 2018 22:24:26 EST Attachments: Thanks You we re 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 AP I - 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 provide r 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) will eventua lly. 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; lperl2528@gmail.com Subject: [EXTERNA L] 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-I-001377 Page 2 107 of t~f~ of 1380 iniatives Sent from my iPad Bruce Moskowitz M.D. On Feb 27, 2018, at 9:20 PM, Bruce Moskowitz 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 wrote: This is a problem it should say open cloud to all entities 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: #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 . VA-18-0298-I-001378 Page 2 108 of t~f~ of 1380 #3) Below is the IP language that we negotiated. l(b)(S) (b)(S) 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 VA-18-0298-I-001379 Page 2109 of ~~Wi of 1380 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-I-001380 Page 2 110 of t~S~ of 1380