S02 Attachment 2 VA OEHRM Site Infrastructure Requirements.docx

OEHRM Site Infrastructure and End User Device (EUD) Requirements April 16, 2020 | Version 1.6 Final Review

John Short Chief Technology & Integration Officer Veterans Affairs Office of Electronic Health Record Modernization

Paul Tibbits, MD Executive Director, Office of Technology Integration Veterans Affairs Office of Information and Technology

Edward A. Litvin, PE, CHFM Deputy to the Assistant Deputy Under Secretary for Health, Administrative Operations Veterans Health Administration

Revision History

Transforming Health Care for Veterans, Revolutionizing Health Care for All

Pre-Decisional - OEHRM Site Infrastructure and End User Device Requirements v1.6 Final | 3

Table of Contents

Overview The Office of Electronic Health Record Modernization (OEHRM) Program is a large-scale, commercial Electronic Health Record (EHR) implementation. The Department of Veterans Affairs (VA) must ensure that the new EHR is supported by both proper Information Technology (IT) infrastructure and physical (i.e., facilities) infrastructure. This document is intended to outline the current set of OEHRM requirements. Specific items evaluated within this document are: Wide Area Networking (WAN), Local Area Networking (LAN), Wireless LAN (WLAN), Power, Heating, Ventilation, and Air Conditioning (HVAC), End User Devices (EUD), Networking and Voice Over Internet Protocol (VOIP).

Requirements Sections 2.1 through 2.10 outline the initial set of requirements for support to OEHRM deployment at Initial Operating Capabilities (IOC) and subsequent wave deployments. In combination with other established requirements documents and plans, these high-level requirements need to be communicated across all stakeholders.

This document provides requirements in addition to VA’s existing design guides and enterprise IT requirements. Additional requirements will supplement specific areas, such as wireless networking, that may require further details. Other site-specific requirements may be issued that develop from evaluation of individual locations. This document will be updated annually over the 10-year deployment schedule to incorporate both technology improvements and lessons learned from deployments. In any area of conflict, the more stringent of the two standards will apply. All included requirements apply to VA Medical Centers (VAMC). Additional site type requirements are outlined in Appendix C.

Wide Area Networking (WAN) WAN Requirements VA Enterprise Data Centers A. VA Enterprise Cloud (VAEC), Austin Information Technology Center (AITC) and Philadelphia Information Technology Center (PITC) shall have, at minimum, Dual 10 Gbps circuit with 1 Gbps CIR minimum from the facility to the Cerner Data Center (2 x 1 Gbps)

1. Moving forward, expected utilization of Cerner EHRM plus current circuit utilization will be averaged to determine required committed information rate (CIR) to meet 50% maximum utilization threshold VAMC Sites A. Facility shall have, at minimum, dual 1 Gigabits per second (Gbps) interface available with ≥ 500 Mbps CIR (2 x 500 Mbps) circuits or bandwidth allocation of peak usage plus 50%, whichever is greater for IOC, Wave 1, 2, and 3.

1. After that OIT, OEHRM, and Cerner will reassess for these sites and the enterprise; Moving forward, expected utilization of Cerner EHRM plus current circuit utilization will be averaged to determine required CIR to meet 50% maximum utilization threshold B. Facility shall have end-to-end, geographically diverse and carrier-diverse circuits with minimum fiber pathways separation: service provider public rights-of-way 75 ft, Egress 20 ft, and cabinet 10 ft. See below Figure 1

1. The preferred entry points 180° apart, or 90° acceptable (protected preferred, unprotected acceptable), with the caveat of Veterans Health Administration (VHA) providing space; all variances to be approved by OEHRM Chief Technology & Integration Officer. See below Figure 2

i. Carrier provided route map shall be used to validate route diversity Figure 1: Minimum Geographic Diversity Circuits with Entry Points

Figure 2: Preferred Geographic Diversity Circuits with Entry Points Other Site Types as Required A. Facility shall have, at minimum, a single 100 Megabits per second (Mbps) (1 x 100 Mbps) circuit with ≥ 50 Mbps CIR or bandwidth allocation of peak usage plus 50%, whichever is greater for IOC, Wave 1, 2, and 3

1. After that OIT, OEHRM, and Cerner will reassess for these sites and the enterprise; Moving forward, expected utilization of Cerner EHRM plus current circuit utilization will be averaged to determine required CIR to meet 50% maximum utilization threshold

2. Following Go-Live, OIT, OEHRM, and Cerner will assess circuit utilization and adjust CIR accordingly WAN Implementation Specifications and Considerations A. Details on Quality of Service (QoS) can be reference in the existing VA document: *Veterans Affairs Enterprise Infrastructure Standard: Quality of Service (QoS) B. Active-Active High Availability (HA) Redundancy in accordance with facility type per the VA Enterprise Local Area Network (LAN) Technical Architecture Standard Version 2.1, February 13, 2019 C. Encryption Protocol: OEHRM requires an end-to-end WAN encryption solution such that traffic from VA locations can go directly to Cerner enclave without having the encryption broken and re-encrypted D. Power / Environmental / Switching / Topology Compliant with TIA-942 Rating 3 E. Performance Service Level Agreements (SLA) 99.99% (per Networx SLA) F. End-to-End latency from the user desktop to Cerner Data Center of equal to or less than 90ms for Citrix connection Local Area Networking (LAN) A. Category 6A cable (CAT6A) unshielded twisted pair (UTP), with additional slack, as required, to relocate if telecommunications room (TR) wiring closet pending move. Otherwise, normal Building Industry Consulting Service International (BICSI) Standards; CAT6 will be grandfathered; CAT5e is identified as an approved solution to provide OEHRM 1Gb to the desktop requirement per Electronic Health Record Modernization Cabling Infrastructure (VIEWS 01426385) per the Assistant Secretary and Chief Information Officer for Office of Information and Technology decision memorandum, September 23, 2019 B. Compliant with the BICSI standards (ANSI/NECA/BICSI 568, Standard for Installing Commercial Building Telecommunications Cabling and ANSI/TIA-1179-A Healthcare Facility Telecommunications Infrastructure for new installations)

1. New cable installations additionally shall be compliant with TIA 568.2-D, TIA TSB-184-A, and NFPA-70 Section 725.144 to prevent PoE heat accumulation

i. Alternatively, new UTP cabling shall carry a UL listed "LP" (Limited Power) rating C. All patch cables shall be of equal or greater Category for copper, OM or OS level for fiber, to the highest in use in the TR or Data Center D. Cable management shall be implemented for all patch cables in accordance with VA OIT Infrastructure Standards for Telecommunications Spaces insuring proper bend radius, bundling, airflow, support and labeling E. 1 GbE connectivity to desktops, and other EUD F. End-to-End latency from the user desktop to Cerner Data Center of equal to or less than 90ms for Citrix connection G. Available data drops and network ports in Telecommunication Rooms (TR) to support addition of required network printers and medical devices per Cerner Current State Review (CSR)[footnoteRef:2] [2: Requirement contingent on timely delivery of the CSR as noted in the OEHRM Infrastructure Readiness Playbook]

H. HA Redundancy in accordance with facility type per the VA Enterprise Local Area Network (LAN) Technical Architecture Standard Version 2.1, February 13, 2019 I. Utilize high-performance network switches with low latency and minimal packet loss for appropriate infrastructure job function and growth per VA business growth forecast

1. No site should go-live with any switch that is within one (1) year of Last Day of Support (LDoS) or End of Software Maintenance (EoSW)

2. Switches that are “stacked” or daisy-chained together sharing an uplink to the core should have an interconnection speed of 10Gbps or greater J. Cables shall be certified as meeting or exceeding TIA-EIA-568.1-D (max fixed cable length 90M/295Ft) K. Intra-building Fiber (Horizontal and First Level Backbone)

1. Performance Category: OM4 Laser Enhanced to 40 GbE; OM3 will be grandfathered

2. Performance Specifications: Laser Optimized 50/125 μm fibers with effective modal bandwidth of at least 4,700 MHz∙km at 850 nm

3. Mode: Multimode

4. Smoke Rating

i. Riser cable for vertical runs through floors

ii. Plenum rated for plenum spaces

iii. Not rated for other applications

iv. Or as per Authority Having Jurisdiction (AHJ) requirement

5. Jacket Color: Aqua

6. Termination Method: Pre-terminated with Multi-fiber Push On (MPO) (Long run cables and campus network cables will have terminations completed in the field, as required)

7. Strand Count: 12 or 24 per assembly

8. Bundling: Loose Tube

9. Polarity: Straight (or Type A-Key up one end, and key down on the other) L. Campus Area Network (CAN) connection by Single Mode (SM) OS2 Fiber 10 GbE or better for building-to-building

1. Single Jacket Non-armored Loose Tube fiber cable for running in conduit

2. Armored fiber for direct-buried or aerial runs

3. All dielectric

4. Outside Plant, Communications Multipurpose Cable, Riser (CMR) “riser-rated cable” Rating

5. 96 Count (if not enough room, smaller count cables can be used)

6. Field-Terminated M. All CAN fiber connections may be home run back to intermediate distribution switch/fiber distribution panel (FDP). Fiber connections at building should not be run through additional buildings unless pass-through or mesh; no “daisy chain”" N. CAN – minimum of 10 Gbps LAN links or matched Small Coarse wavelength division multiplexing (CWDM); VHA responsible for Fiber and OEHRM will fund small form pluggable (SFP) 10Gbps transceivers; NOTE: Not required for Go Live at IOC facilities O. Connections for Core, Distribution and uplink from Access Switch shall provide a minimum of 10 GbE Fiber or better; VHA responsible for Fiber and OEHRM will fund small form pluggable (SFP) 10Gbps transceivers; NOTE: Not required for Go Live at IOC facilities P. Power / Environmental / Switching / TopologyTIA-942 Rating 3 Q. Network Infrastructure devices supported by UPS and Emergency Power / Backup Generator as described below in 2.4 R. Performance Service Level Agreements (SLA) 99.9% excluding scheduled downtime Wireless LAN (WLAN) Design Requirements This section covers basic VA secure WLAN requirements. Detailed WLAN requirements are contained in a supplemental document, VA OEHRM Wireless Network Infrastructure A. 802.11ac Wave 2 & when commercially available next-generation 802.11ax B. Power over Ethernet (PoE), 802.3at PoE+ (30W per channel at PoE source, 25.5W at PoE device) C. CAT6A cable to access point (AP) D. Compliant with VA Telecommunications and Special Telecommunications Systems Design Manual and TIA TBS-162-A, Telecommunication Cabling Guidelines for Wireless Access Points Power and Space Design Requirements Deployment includes a JSA security stack (also known as Network Protection Suite (NPS)) and a Forward Deployed Server (FDS) stack equipment element in the overall infrastructure requirement.

“Stack” is defined as each grouping of server and network equipment. FDS equipment is provided by Cerner. JSA security stack is provided by OIT.

A. JSA Security Stack estimated power and space requirements are based on BOM provided to Seattle IOC site as follows: Comment by Doolittle, Cynthia (VISN 23): Is this true for all sites? They'll use Seattle IOC BOM?

Expected Continuous Power Consumption - 208VAC, 11.5A, 2,395W Maximum Utilization Power Consumption - 208VAC, 15.3A, 3,185W

1. Rack space of 11U, contiguous shall be provided in the MDA, near core switches or with the VA LAN Security stack

i. WAN Demarc must be extended to installation location if the JSA is not colocated

ii. Copper or fiber cabling shall be provided between the JSA and Core switches if not colocated

2. Power supporting the JSA Security Stack (NPS) equipment shall be supplied in accordance with sheet 20 of the OIT Design Guide templates dated 27 December 2018

i. A/B redundant 3-phase 208V Rack PDUs providing 7 A-branch and 7 B-branch IEC type C-13 outlets

ii. A and B branch shall be attached to diverse UPSs, each capable of supporting Expected Continuous Power Consumption in 2.4 A B. FDS equipment estimated power and space requirements are based on Seattle IOC deployment as follows:

Expected Power Consumption - 208VAC, 33.5A, 6,876W and Maximum Utilization Power Consumption - 208VAC, 47.5A, 9,880W

1. Local Facilities Management shall provide:

i. Space for 3, Standard Width, Standard Depth Server Cabinets

a. At least 2 cabinet spaces shall be located side by side

ii. Zone PDUs shall be provided to distribute power to cabinet PDUs, one per two cabinets

a. Zone PDU shall be configured with dual path L21-30P connectors

b. Zone PDU shall provide at least 4 L21-20R outlets to support cabinet PDUs

c. Zone PDUs shall receive power from L21-30R outlets located within 6 feet of the base of the cabinet

iii. Power distribution configuration shall provide paths to diverse UPSs, each capable of supporting the Expected Continuous Power Consumption of 3.5 kW per cabinet Note: Request for variance in power or space requirements for the FDS equipment shall be addressed to and approved by OEHRM Chief Technology & Integration Officer. The memo shall be delivered by the Director of HEFP no later than 26 months prior to go-live. An example memo is included in Appendix D: Supporting Documents - B. FDS Power and Space Exemption Memo Example

2. Cerner shall provide up to 3 cabinets housing the FDS equipment

i. Estimates of Expected Power Consumption and Maximum Utilization Power Consumption shall be calculated per cabinet and provided to OEHRM 13 months prior to go-live

ii. The FDS equipment shall be installed with systems mounted in agreed upon locations such that cabinets from different facilities have identical layouts

1. 2U of contiguous space at the base of Rack 1 (and Rack 3 if necessary) shall be reserved for installation of the Zone PDU

iii. Equipment shall be labeled with environment type and network name

iv. Cabinets shall be used exclusively to support EHRM equipment

v. Installed equipment will not exceed total Expected Power Consumption of 3.5 kW per cabinet

vi. Each cabinet shall provide redundant cabinet PDUs

1. Cabinet PDUs shall be configured with L21-20P connectors, consistent with the power distribution topology in the Telecommunications Infrastructure Specification v.2.2

2. Cabinet mounted equipment shall have redundant power supplies that shall be connected to redundant cabinet PDUs

vii. Provided cabinets shall be 45RU, 24" nominal width

viii. Blanking panels shall be installed in all open rack units

ix. Cabinets shall be equipped with seismic mitigation when deployed in facilities categorized as Critical and earthquake risk is confirmed by the VA Seismic Safety Coordinator (Veterans Affairs OCFM H-18-8 Seismic Design Requirements, November 1, 2019) Note: All qualifying facilities are listed in Appendix E: Facilities Requiring Seismic Mitigation in Cabinets C. UPS Functional Requirements

1. All UPS units to be functional and adequate in all Telecommunication Rooms (VAMC with 20-minute run-time; other locations with 30-minute run-time) (Reference. The U.S. Department of Veterans Affairs, Physical Security Design Manual for Mission Critical Facilities, January 2015)

2. All units within one (1) year of end of life by Facility Go-Live are to be replaced with new units

i. End of Life for stand-alone units assumed to be six (6) years from date placed into service

ii. End of Life for UPS batteries assumed to be three (3) years from date replaced

3. All equipment in TR shall be connected to the critical electrical branch and Emergency Power / Backup Generator, where required in Mission Critical facilities, in accordance with VHA Directive 1028 FACILITY ELECTRICAL POWER SYSTEMS, dated February 24, 2020 D. All Network Switch, JSA and FDS equipment shall be supported by adequate UPS power whether located in Data Center, MDA or TR E. New equipment install must comply with Single point grounding per ANSI/NECA/BICSI 607-C, Generic Telecommunications Bonding and Grounding (Earthing) for Customer Premises November 2015 F. The main facility power feed to the data center must meet additional power requirements listed above at paragraph 2.4.A.2 combined with 2.4.B.2 Heating, Ventilation, and Air Conditioning (HVAC) Design Requirements A. Room temperature and relative humidity values should adhere to the U.S. Department of Veterans Affairs Office of Construction & Facilities Management HVAC Design Manual, dated May 1, 2019

1. VA data center environmental requirements are classified as Environmental Class A1 per American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) TC9.9 modified for the VA operating environment, IT equipment inlet temperature range of 72°F to 81°F, humidity ≤ 60 percent noncondensing

2. TR Wiring Closet Class B space temperature range 41°F to 95°F, relative humidity: 8 to 80% noncondensing

i. TR Wiring Closet Environmental Monitoring Solution for temperature and humidity (e.g. Uninterruptible Power Supply (UPS) with Network Management Card, Temperature & Humidity Sensor, and Central Monitoring by way of a single network connection is required using a RJ-45 Patch Cable)

ii. In areas where there are environmental issues (e.g., steam pipes, lack of ventilation, etc.), the use of thermal curtains and additional vents will be considered as a temporary alternative, not permanent resolution B. Provide N+1 redundant cooling capacity for the new total thermal load in data centers; Equal to the existing thermal load plus the following additional heat releases as measured in Watts

1. JSA, expected thermal load 2,395W

2. FDS, expected thermal load 6,876W, potential thermal load 10,500W (3 full cabinets) C. Top-of-rack network equipment shall be configured to receive supply air from the front (cold) face of the cabinet. Airflow control measures shall be used to prevent hot air recirculation to device intakes D. Continuous thermal load should not exceed 3.5 kW for any existing or additional rack or cabinet E. Blanking panels shall be installed in all open rack units, in Data Center cabinet and racks, to prevent hot exhaust air recirculating to the cold air equipment intake side of the rack. This requirement is shown in the following figure:

Figure 3. Blanking Panel Applications Reference: Section 3.1.3.1, Data Center Facility Environment Conditioning Standards, Figure 8, page 42, Office of Information & Technology (OIT) Infrastructure Standards for Telecommunications Spaces, Version 2.2, April 10, 2019 End-User Devices (EUD) PC Requirements All EUD PCs must meet the recommended or greater requirement levels.

A. General EUD PC and peripherals:

1. Processor: Dual or more Core Processor (i5, i7 or equivalent) running at 2.0GHz or greater, Support for AES-NI

2. RAM: 16GB DDR4 SDRAM 2,400MHz

3. Hard Drive: 512 GB NVMe PCIe M.2 SSD

4. Display/Graphics: Integrated High Definition (HD) graphics with of 512 MB shared memory or more provided, dedicated memory preferred, Dual Monitor Support

5. Monitor: 22” (minimum) or 24” (recommended), Resolution of 1920 x 1080 or higher and 32-bit color

i. Appropriate monitor size for locations where physical limitations restrict the use of recommended monitor sizes will be determined on a case by case basis

ii. Display size for laptops shall meet the end user’s requirements for their intended laptop use

iii. If a docking station is provided the docked monitor shall meet the requirements stated above

6. Network: Network Port 1 GbE, RJ-45. Wireless interface shall support 802.11a/n/ac (2x2) and, a FIPS-140-2 encrypted communications and 5 GHz support

7. Peripheral: 101-key keyboard and mouse or equivalent

8. O/S: Windows 10 Pro 64 with Internet Explorer 11

9. Citrix Receiver: 14.9 or later as required by TRM

10. Access: PIV Card Reader

11. Other Software: VA Image as appropriate B. Clinical Imaging-Diagnostic Viewing EUD PC and peripherals:

1. Processor: Intel Skylake Hexa Core w/HT Technology 3.7GHz or better

2. RAM: 32GB

3. Hard Drive: 512 GB PCIe NVMe M.2 SSD

4. Display/Graphics: Barco MXRT-5600 or NVIDIA Quadro P2000, Dual Monitor Support

5. Monitor:

i. 22” (minimum), Resolution of 1920 x 1080 or higher, and 32-bit color

ii. 27” monitors, Resolution of 2560 x 1440 or higher, total of 3 monitors is suggested for the optimal workflow, 2 for viewing images and 1 for charting

iii. Appropriate monitor size for locations where physical limitations restrict the use of recommended monitor sizes will be determined on a case-by-case basis

6. Network: Network Port - 1 GbE RJ-45. Wireless is not recommended

7. Peripheral: 101-key keyboard and mouse or equivalent

8. O/S: Windows 10 64-bit

9. Access: PIV Card Reader C. Clinical Imaging-Technologist EUD PC and peripherals:

1. Processor: Intel Skylake Quad Core w/HT Technology 3.0GHz or better

2. RAM: 16GB

3. Hard Drive: 512 GB PCIe NVMe M.2 SSD

4. Display/Graphics: Barco MXRT-5600 or NVIDIA Quadro P2000, Dual Monitor Support

5. Monitor:

i. 22” (minimum), Resolution of 1920 x 1080 or higher, and 32-bit color

ii. 27” monitors, Resolution of 2560 x 1440 or higher

iii. Appropriate monitor size for locations where physical limitations restrict the use of recommended monitor sizes will be determined on a case-by-case basis

6. Network: Network Port - 1 GbE RJ-45. Wireless is not recommended

7. Peripheral: 101-key keyboard and mouse or equivalent

8. Operating system (OS): Windows 10 64-bit

9. Access: PIV Card Reader Other EUD Requirements All peripheral devices must be validated for use with Cerner Millennium. Use the Cerner Validated Peripheral List (VPL) to assess compatibility. The version of VPL at time of creation of this document is included in Appendix E: with a link to the most current version. Follow these steps to assess a device:

1. Verify the device Manufacturer and Model are listed (see Figure 4 below for an example)

2. Verify the associated Status column for the device contains A for ‘Active’ status

3. Verify the associated Applications column shows ‘ML’ signifying Cerner Millennium 1.

2.

3.

Figure 4: Determining Validated Peripherals using the Cerner Validated Peripheral List Laser Printer and Multi-Function Printers (MFP) Requirements A. Laser Printers and MFP devices shall be network attached with a static IP address B. Laser Printers and MFP devices shall be compatible with (OIT) Printer and Multifunction Device Secure Configuration Baseline.

Wireless EUD Requirements VA sensitive information, as defined by VA Directive and Handbook 6500, must not be transmitted via wireless technologies unless Federal Information Processing Standards (FIPS) 140-2 validated encryption is installed and operating as intended (VA DIRECTIVE 6512 - SECURE WIRELESS TECHNOLOGY) A. Exemptions from this requirement are allowed for IOC and Waves 1-8. A Plan of Action and Milestones (POAM) must be completed and approved by the facility Information System Security Officer (ISSO) prior to deploying a non-compliant wireless device Mobile EUD Requirements If the determination is made that Mobile Devices are required, those requirements will be included in this section.

Voice Over Internet Protocol (VOIP) Device Requirements A. VOIP Phone / Device shall be capable of 1GbE pass-through B. Network switches supporting VOIP Phone / Device shall be capable of delivering adequate Power over Ethernet (PoE) to all attached devices C. VOIP Phone / Device shall utilize Category 6 or higher patch cable for both connection of EUD to phone and phone to network Medical Device Requirements If the determination is made that Medical Devices require unique supporting infrastructure those requirements will be included in this section.

Physical Security Design Requirements Rooms undergoing modifications and upgrades will comply with current physical security design requirements as follows:

Mission Critical Facilities A. U.S. Department of Veterans Affairs Office of Construction & Facilities Management Telecommunications and Special Telecommunications Systems Design Manual, February 2016 B. U.S. Department of Veterans Affairs Physical Security Design Manual for Mission Critical Facilities, January 2015 C. U.S Department of Veterans Affairs Office of Information & Technology (OIT) Infrastructure Standards for Telecommunications Spaces Version 2.2 April 10, 2019 Life Protected Facilities A. U.S. Department of Veterans Affairs, Physical Security Design Manual for Life Protected Facilities, January 2015 B. U.S Department of Veterans Affairs Office of Information & Technology Infrastructure Standards for Telecommunications Spaces Version 2.2 April 10, 2019 Joint Security Architecture Requirements JSA shall be required to provide network connectivity to the Medical Community of Interest (MEDCOI) network for access to Joint Electronic Health Record system hosted within Cerner's data centers. Additional functionality includes providing advance network protection and visibility into network traffic. Specific requirement can be found in the OEHRM Joint Security Architecture (JSA) Requirements Specifications Document (RSD)

Appendix A: Acronyms

Transitional Residence

Appendix B: References The following were used as references for this document:

1. U.S Department of Veterans Affairs Office of Construction & Facilities Management Telecommunications and Special Telecommunications Systems Design Manual February 2016 https://www.cfm.va.gov/til/dManual/dmTelecomm.pdf

2. U.S Department of Veterans Affairs Office of Information & Technology (OIT) Infrastructure Standards for Telecommunications Spaces Version 2.2 April 10, 2019 https://www.cfm.va.gov/til/dguide/OIT-InfrastrucStdsTelecommSpaces.pdf

3. ANSI/NECA/BICSI 568, Standard for Installing Commercial Building Telecommunications Cabling

4. ANSI/TIA-1179-A Healthcare Facility Telecommunications Infrastructure for new installations

5. TIA TBS-162-A, Telecommunication Cabling Guidelines for Wireless Access Points

6. ANSI/NECA/BICSI 607-C, Generic Telecommunications Bonding and Grounding (Earthing) for Customer Premises November 2015

7. VA OEHRM Wireless Network Infrastructure - Requirements Specification Document - v 1.7 https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx

8. U.S Department of Veterans Affairs Office of Information and Technology CFM/OIT DESIGN GUIDE TEMPLATES FOR CRITICAL TELECOMMUNICATIONS SPACES IN CLINICAL AND NON-CLINICAL ENVIRONMENTS Dec 27, 2018 https://www.cfm.va.gov/TIL/dGuide/OIT-DGTemplates-CriticalTelecommSpaces.pdf

9. The U.S. Department of Veterans Affairs, Physical Security Design Manual for Mission Critical Facilities, January 2015 https://www.cfm.va.gov/til/PhysicalSecurity/dmPhySecMC.pdf

10. U.S Department of Veterans Affairs Enterprise Infrastructure Standard: Quality Of Service(QoS) https://vaww.vashare.oit.va.gov/sites/itops/svcs/sma/BCM/Approved_Baselines/VA%20Enterprise%20IT%20Infrastructure%20(QoS)_1-14.pdf

11. U.S. Department of Veterans Affairs Office of Construction & Facilities Management HVAC Design Manual dated Revised May 1, 2019 https://www.cfm.va.gov/til/dManual/dmHVAC.pdf

12. U.S Department of Veterans Affairs Enterprise Local Area Network (LAN) Technical Architecture Standard, Version 2.1, February 13, 2019 https://vaww.vashare.oit.va.gov/sites/itops/svcs/sma/BCM/Supporting_Documents/Enterprise%20Local%20Area%20Network%20(LAN)%20Technical%20Architecture%20Standard_v2.1.pdf

13. VHA Directive 1028 FACILITY ELECTRICAL POWER SYSTEMS, dated February 24, 2020 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8723

14. OEHRM Joint Security Architecture (JSA) Requirements Specifications Document (RSD) – Draft, not available for public review https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx

15. U.S Department of Veterans Affairs Electronic Health Record Modernization Cabling Infrastructure (VIEWS 01426385) Executive Decision Memorandum, dated September 23, 2019 (attached)

16. VA Systems Engineering Solution, Cerner EHRM Forward Deployed Servers, dated April 12, 2019 (attached)

17. VA DIRECTIVE 6500 VA CYBERSECURITY PROGRAM Reissue 4 dated January 29, 2019

18. VA DIRECTIVE 6512 SECURE WIRELESS TECHNOLOGY dated October 12, 2017

19. U.S Department of Veterans Affairs Office of Information & Technology (OIT) Printer and Multifunction Device Secure Configuration Baseline Version 1.4 August 5, 2019 https://vaww.vashare.oit.va.gov/sites/itops/svcs/sma/BCM/Approved_Baselines/Printer%20and%20Multifunction%20Devices%20Secure%20Configuration%20Baseline.pdf

20. VHA Handbook 1006.02 VHA SITE CLASSIFICATIONS AND DEFINITIONS dated December 30, 2013

21. U.S Department of Veterans Affairs Pharmacy Benefits Management Services https://www.pbm.va.gov/PBM/CMOP/VA_Mail_Order_Pharmacy.asp

22. Consolidated Patient Account Center (CPAC) Supports VA’s commitment to Veteran Healthcare https://www.va.gov/CBO/cbo/cpac/docs/fs_veterans_01.pdf

23. U.S Department of Veterans Affairs Clinical Resource Hub Training and Operations Guide https://vaww.portal2.va.gov/sites/PERC/CR_HUB/CRH_Documents/CRH%20Guidance%20and%20Overview/Clinical%20Resource%20Hub%20Training%20and%20Operations%20Guide.docx?Web=1

24. U.S Department of Veterans Affairs VA Health Now “Your Clinical Contact Center” https://www.visn8.va.gov/VISN8/Documents/V08_CCC_InfoSheet_3.pdf

25. OPM Frequently Asked Questions: “What is telework?” https://www.opm.gov/FAQs/QA.aspx?fid=b48bf83b-440c-4f1e-a88c-3cdc9d802ac8&pid=75346675-3b92-4aec-831d-58cf5b0e86d2

26. OEHRM Infrastructure Readiness Playbook – Draft, not available for public review https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx

27. Veterans Affairs OCFM H-18-8 Seismic Design Requirements, November 1, 2019 https://www.cfm.va.gov/til/etc/seismic.pdf

28. VHA DIRECTIVE 1044 ASSIGNMENT AND MAINTENANCE OF STATION NUMBERS AND ATTRIBUTES dated March 15, 2016

Appendix C: Non-VAMC Site Type Definitions and Requirements Definitions and requirements for Non-VAMC sites are described in the following sections.

A. Community-Based Outpatient Clinic Definitions A community-based outpatient clinic (CBOC) is a VA-operated, VA-funded, or VA-reimbursed site of care, which is located separate from a VA medical facility. A CBOC can provide primary, specialty, subspecialty, mental health, or any combination of health care delivery services that can be appropriately provided in an outpatient setting. CBOCs are further classified as two types:

A. A Multi-Specialty CBOC is a VA-owned, VA-leased, mobile, contract, or shared clinic that offers both primary and mental health care and two or more specialty services physically on site. Access to additional specialty services may be offered by referral or telehealth. These clinics may offer support services, such as pharmacy, laboratory, and x-ray. These clinics are permitted to provide invasive procedures with local anesthesia or minimal sedation, but not with moderate sedation or general anesthesia.

B. A Primary Care CBOC is VA-owned, VA-leased, mobile, contract, or shared clinics that offer both medical (physically on site) and mental health care (either physically on site or by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. Access to specialty care is not provided on site, but may be available through referral or telehealth. A Primary care CBOC often provides home-based primary care (HBPC) and home telehealth to the population it serves.

B. Health Care Center (HCC) Definition The HCC is a VA-owned and leased clinic. It is contracted or shared and operates at least 5 days per week. Services provided include primary care, mental health care, and on-site specialty services. They perform ambulatory surgery and/or invasive procedures which may require moderate sedation or general anesthesia.

i. The HCC designated as an ambulatory surgery clinic (ASC) must meet the requirements of the assigned surgical complexity level and provide all associated support infrastructure, such as pharmacy, laboratory, and x-ray, to perform these health care services safely and effectively.

ii. The HCC not designated as an ASC but performing invasive procedures under moderate sedation must meet criteria established by VHA Directive 2006-023, Moderate Sedation by Non- Anesthesia Providers.

iii. The HCC either assigned an ASC designation or performing invasive procedures under moderate sedation or anesthesia must comply with external accrediting bodies’ standards for ambulatory surgery centers and/or provision of anesthesia or moderate sedation.

C. CBOC and HCC Specific Requirements

D. Clinical Resource Hub (CRH) Definition A repository of staff serves a VISN and provide clinical services via virtual and in-person care. This is for VA facilities experiencing clinical gaps or designated as underserved facilities. Staff within a CRH include: Primary Care Providers, Clinical Pharmacy Specialist providers, Psychologists, Psychiatrists, Licensed Clinical Social Workers, Registered Nurses, Administrative Associates, CRH Training and Operations Guidance.

E. Clinical Contact Center Definition Veterans who receive care in the VISN network can call around the clock to get their health questions answered from the convenience of their home, or wherever they may be. Services include general administrative support, nurse advice and triage, virtual visits with a doctor or nurse practitioner via telephone or VA Video Connect. There are no co-payments for using the VA Health Now “Your Clinical Contact Center” F. Consolidated Mail Order Pharmacy (CMOP) Definition The Department of Veterans Affairs provides approximately 80% of all outpatient prescriptions to Veterans via mail order utilizing the VA Mail Order Pharmacy, a system of 7 highly automated pharmacies. The VA Mail Order Pharmacy processes 470,000 prescriptions daily. Every workday over 330,000 Veterans receive a package of mailed prescription medications. (Source: Pharmacy Benefits Management Services website) G. Consolidated Patient Account Center (CPAC) Definition Consolidated Patient Account Centers were created by Congressional mandate to consolidate traditional VHA business billing and collections office functions into seven regional centers. Veterans or family members with private health insurance or with federally funded coverage through the Department of Defense (TRICARE) can make payments or ask questions in person, by phone, online and by mail. Facilities are in Asheville NC, Smyrna TN, Middleton WI, Orlando FL, Lebanon PA, Leavenworth KS, and Las Vegas NV. Each center supports a specific region of the United States.

H. Extended Care Site Community Living Center (CLC) (Stand-Alone) Definition Extended care is defined by encounters between Veterans and providers within the VHA health care system either in VA institutional care or VA non-institutional care. Extended care services include geriatric evaluation, nursing home care, domiciliary services, adult day health care, other noninstitutional alternatives to nursing home care, and respite care. VA institutional extended care is provided in beds associated with overnight institutional extended care programs. VA institutional extended care beds are defined by the treating specialty. There are three subtypes of institutional extended care beds: CLC short-stay, CLC long-stay, and CLC hospice.

I. Residential Care Site (MH RRTP/DRRTP) (Stand-Alone) Definition Two programs are classified as “residential care” in the site classification: Residential Rehabilitation and Domiciliary Care (most residential rehabilitation programs are types of domiciliary care). Specifically, a Mental Health Residential Rehabilitation Treatment Program (RRTP) provides residential rehabilitative and clinical care to eligible Veterans who have a wide range of problems, illnesses, or rehabilitative care needs. These can be medical, psychiatric, SUD, homelessness, vocational, educational, or social services. The term RRTP refers to the bed category and includes the following programs: Domiciliary Residential Rehabilitation Treatment Programs (DRRTP), Domiciliary Care for Homeless Veterans (DCHV), Health Maintenance Domiciliary, Psychosocial Residential Rehabilitation Treatment Programs (PRRTP), PTSD Residential Rehabilitation Treatment Program (PTSD-RRTP), Substance Abuse Residential Rehabilitation Treatment Program (SARRTP), and Compensatory Compensated-Work Therapy (CWT)-Transitional Residence (TR).

J. CRH, Clinical Contact Center, CMOP, CPAC, CLC and MH RRP/DRRTP Specific Requirements

K. Other Outpatient Services (OOS) Definition Many of the services provided at these sites are like those provided in Veteran Centers. Other clinical services are provided to remote areas through a Telehealth clinic or other arrangement. If any other services are provided in this venue (external to a VA clinic or facility), they must be associated with, attached to, and coordinated by a health care delivery site located in a clinic or facility.

L. Vet Center Definition Services provided at these sites are contacts made by VA or VHA personnel to provide information, social services, homelessness outreach services, activities to increase Veteran awareness of benefits and services, and support services.

M. OOS, Vet Centers and Call Center Specific Requirements Call Center Examples include VHA Member Services, Rev Ops Call Center and National Call Centers.

N. Teleworker with Printer Definition The term 'telework' or 'teleworking' refers to a work flexibility arrangement under which an employee performs their stated duties and responsibilities, and other authorized activities, from an approved worksite other than the location from which the employee would otherwise work.

O. Teleworker with Printer Specific Requirements

P. Central Scheduling Solution (CSS) Definition Central Scheduling Solution deploys the Outpatient scheduling portion of the Cerner EHR to coordinate and optimize utilization of physician resources in the outpatient setting. The functionality will provide a critical, longitudinal view of wait times and availability of care for veterans delivering improvements in customer service and customer experience. CSS is slated to be delivered 2 years prior to the OEHRM facility wave schedule.

Q. CSS Site Requirements The CSS requirements stated in this section are used at a VAMC or CBOC prior to deployment of the full Cerner feature set. Requirements are intentionally stated in a separate document and included here for reference. The document can be found here: https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx

Appendix D: Cerner Validated Peripheral ListSupporting Documents A. Cerner Validated Peripheral List Follow this link for most current Validated Peripheral List version:

OTI Integration SharePoint - Validated Peripheral List

The Original Validated Peripheral List is available on Cerner’s Support Website here: https://wiki.cerner.com/display/public/Peripherals/VPL (Requires login)

Version at signing:

A.

B. FDS Power and Space Exemption Memo Example Which SharePoint – HEFP I think?

Appendix E: Facilities Requiring Seismic Mitigation in Cabinets The table field heading descriptions are as follows:

· Wave: Agreed to, staggered deployment date grouping for VAMC locations in the OEHRM-Cerner Contract

· STA6N: The combination of Station Number and Suffix Modifier used to track individual care locations from the VHA Site Tracking (VAST) system

· Station Number: The station number identifies unique points of service within VHA. The station number is used by the VHA site classification process to identify the workload associated with individual sites of care. The station number list is maintained by the VA Office of Financial Services Center and is tracked by point of service using the VAST database.

· Suffix Modifier: A suffix modifier is an appendage to the station number of up to three positions used to identify substation elements attached to a parent station.

· Official Station Name: VAST name of VHA Station

· City: STA6N US Postal Service address City

· State: STA6N US Postal Service address State

· Zip: STA6N US Postal Service address Zip The following seismic mitigation list is sorted by “Wave” implementation.