SOW Attachment 14 - OEHRM Infrastructure Readiness Playbook Version 2.0.pdf

Transforming Health Care for Veterans, Revolutionizing Health Care for All

OEHRM Infrastructure Readiness Playbook

July 23, 2020 | OEHRM / TIO Version 2.0

V2.0 OEHRM Infrastructure Readiness Playbook (iPlaybook)| ii

Signature Page

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

Paul Tibbits, MD Executive Director Office of Technical Integration

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

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Table of Contents Electronic Health Record Modernization (EHRM) Overview

Document Purpose

Intended Audience

Construction Background

IT Infrastructure Background

Infrastructure Readiness Processes Construction Collaboration Flow Chart

Facilities Concept of Operations (CONOPS) Model

Construction and IT Infrastructure Plans and Roadmap Enterprise Level Oversight

Risk Management

Risk Mitigation Strategy

Schedule and Milestones Management

4.3.1 Milestones Management

Communications Plan and Tools

Stakeholder Management Process

Budget: Acquisitions and Procurement

4.6.1 Funding Profiles and Organization Process

4.6.2 OEHRM Investment Justification Package (IJP)

4.6.3 OEHRM Funding and OIT Projects

4.6.4 VHA SCIP/ Drives Resources Augmentation Requirements

RACI Matrix: Organizational Expectations

Facility Infrastructure Planning Kickoff

Facility Assessments

5.2.1 Site Self-Assessment

5.2.2 Cerner Current State Review (CSR)

5.2.2.1 Closet Assessment

5.2.2.2 Future State Equipment

5.2.3 Review Assessments to Define Scope of Construction Projects Facility Enterprise Design

Facility Training Space

IT Infrastructure Planning Infrastructure Installation

6.1.1 Physical Infrastructure Upgrades

Cerner-Provided EHR Planning

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6.2.1 Forward Deployed Service Server (FDSS) Installation

Network Infrastructure

6.3.1 Network and Security Design

Joint Security Architecture (JSA)

EUD Deployment

6.5.1 EUDs

6.5.2 Printers/Scanners

6.5.3 Medical Devices

6.5.4 Voice Over Internet Protocol (VOIP)

IT Installation: Training-Testing-Help Desk Space

6.6.1 Testing Space: Integration Validation Testing

6.6.2 Temporary Cerner Space: Command Center/Help Desk

Site Acceptance Test Plan

Deployment EUD Deployment

Cerner Deployment

Cerner Go Live Help Desk

7.3.1 VA ESD/Cerner MSD Bi-Directional Help Desk Interface implemented EHRM End User Help Desk Support

Go-Live: Site Activation Appendix A: OEHRM Construction and Infrastructure Stakeholders Appendix B: Site Infrastructure Plan Appendix C: Roles and Responsibilities Appendix D: Acronym List Appendix E: References Appendix F: Infrastructure and Implementation Wave Chart Appendix G: Infrastructure Deployment Timeline Appendix H: Long Lead Milestones Tracking Appendix I: Cutover Plan & DRP Playbook Overview

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Electronic Health Record Modernization (EHRM) Overview The Department of Veterans Affairs (VA) is embarking on the introduction of a commercial Electronic Health Record (EHR) system to serve as a single source of health information for all Veterans and active duty military personnel. This structure will maximize Department of Defense (DoD) and VA resources to minimize the EHR deployment schedule and change management risks. It will also promote interoperability through coordinated clinical and business workflows, data management, and technology solutions, while ensuring patient safety. The Office of Electronic Health Record Modernization (OEHRM) program office will be responsible for effectively adjudicating functional, technical, and programmatic decisions in support of DoD and VA’s integrated EHR solutions.

The mission of VA is to provide benefits and services to Veterans across the United States. The goal of this initiative is to leverage an existing commercial solution to achieve interoperability within VA, with DoD, and with community care providers. The OEHRM oversees all program (i.e., “the Program”) requirements that are a crucial piece of a larger effort to transform how VA delivers health care.

Document Purpose The purpose of this document is to ensure successful delivery of the OEHRM effort through the Deployment of Cerner Millennium by establishing the high-level functional architecture, organization, roles, responsibilities, processes, metrics and strategic plan and associated infrastructure required to support a new EHR system.

This document will outline all aspects from building infrastructure, physical infrastructure, and Information Technology (IT) infrastructure, including remediations and upgrades that must be completed prior to Go-Live to sustain the new EHR. This playbook serves as a plan that outlines an approach and roadmap for all construction and IT/Facility infrastructure tasks for site activation by providing a standardized deployment aligned to facilities requirements to be used for the local sites and all stakeholders.

The core organizations represented in this playbook include:

• OEHRM Technology Integration Office (TIO).

• OEHRM Chief Medical Office (CMO).

• Veterans’ Health Administration (VHA) Healthcare Environment and Facilities Programs (HEFP).

• VHA Procurement and Logistics Organization (P&LO).

• VHA Facilities.

• Office of Technical Integration (OTI).

• Office of Acquisition, Logistics, and Construction (OALC).

• Cerner Corporation.

Other major programs include the Financial Management Business Transformation (FMBT), Telehealth, VA Logistics Office Redesign (VALOR), and the MISSION Act.

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Intended Audience The intended audience for this Playbook is defined in the following table:

Table 1: Intended Audience

Users Relevant Sections Uses

OEHRM-VHA-OIT

Program Leadership

• Enterprise Level Oversight

• Appendix H: Long Lead

Milestones Tracking

• Appendix I: Infrastructure and

Implementation Wave Chart

Programmatic overview of program management, risks, communications and timelines, dependencies, funding determinations for Infrastructure Readiness

Chief Engineers • Facility Infrastructure Planning

• Appendix E: References

• Appendix H: Long Lead

Milestones Tracking

Facility and Building requirements for construction projects;

preparation for significant change and dependencies on program milestones

IT Personnel • IT Infrastructure Planning

• Appendix E: References

• Appendix H: Long Lead

Milestones Tracking

Guidance on high level requirements and IT infrastructure requirements and associated timelines for site readiness

Area Managers • IT Infrastructure Planning

• Appendix E: References

• Appendix H: Long Lead

Milestones Tracking

Infrastructure Readiness activities required for site activation

Construction Background The VHA Strategic Capital Investment Plan (SCIP) process includes all capital projects (major construction, minor construction, non-recurring maintenance (NRM), and leases) except for information technology non-construction, VHA HEFP tracks and reports on the efforts approved in the SCIP. Building projects based on the gap analysis of the assessments are the output of VHA HEFP projects. SCIP aims to provide an integrated, comprehensive planning process for capital improvement projects. VHA creates an approach that requires determining where gaps exist and develops solutions in collaboration with VA facility level data and including includes Veterans Integrated Service Network (VISN), Memorial Service Network (MSN), Region, or Staff Office level personnel.

Building projects are specific to VHA and reference construction; specific to the physical facility and are to address building and safety standards; also, building projects must address OIT and OEHRM requirements to ensure cross-team collaboration.

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IT Infrastructure Background In an ongoing effort to optimize the current infrastructure state, OEHRM and the Office of Information and Technology (OIT), collaborate to deliver an improved experience to users by completing OIT projects that transform the legacy infrastructure.

OIT projects optimize logical infrastructure and existing facilities; improve security posture; and transition to more efficient infrastructure with consideration given to VA Cloudsmart policy. IT investment decisions for IT infrastructure projects include, but are not limited to, hardware purchases, via the Investment Justification Package process, with the section referenced later in the book. These purchases are managed and tracked by OEHRM.

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Infrastructure Readiness Processes

The Infrastructure Readiness processes guide the process flow of covered topics. OEHRM Infrastructure Readiness recommends reviewing, updating, and incorporating content to accurately depict the IT infrastructure and construction approach. It is the responsibility of VHA and OIT to review the information contained in these roadmaps, coordinate with their respective stakeholders, and raise any issues related to site-specific activities in accordance with assigned RACI designations.

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Construction Collaboration Flow Chart The below flow chart outlines collaboration amongst offices during a specified activity. Collaboration is an ongoing process that will fluctuate as the program develops.

Figure 1: OEHRM Construction Collaboration Flow Chart

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Facilities Concept of Operations (CONOPS) Model The Facilities CONOPS model in the below figure outlines the OEHRM Infrastructure Readiness concepts and framework. This guides program management activities and IT infrastructure, building construction and physical infrastructure related activities.

Figure 2: OEHRM Infrastructure Readiness CONOPS Model

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Construction and IT Infrastructure Plans and Roadmap The OEHRM Program is a large-scale commercial EHR implementation that requires proper infrastructure. OEHRM, OIT and VHA developed Infrastructure plans and roadmaps that articulate the requirements needed to support the new EHR system implementation. The EHR infrastructure requirements require an on-going partnership between OEHRM and OIT, which promotes efficiency, eliminates duplicate work, leverages VA’s economic scale and aligns existing policies/regulations.

OEHRM Infrastructure Readiness determined that the following Building and IT infrastructure components require upgrading to support the new EHR system and improve connectivity to its partners including Cerner:

• Wide Area Network (WAN).

• Local Area Network (LAN).

• Wireless Local Area Network (WLAN).

• Network management/network managed services.

To ensure IT infrastructure upgrades meet VA and Cerner requirements, the below listed plans and requirements were developed by OEHRM and OIT. The OEHRM fully executed Infrastructure Readiness requirements are maintained on the SharePoint site: Construction & Infrastructure IPT.

• Integration Implementation Plan (IIP): Includes the Productivity Surge plan that details augmentation of labor.

• End User Device (EUD) Plan: Specifies deployment plan for EUD (Desktop, laptop, Printer, scanner and other related equipment) as well as requirement for processors, RAM, graphics, network, peripheral, Operating Systems (O/S), access and other requirements.

• EUD Requirements: Specifies hardware requirements for general EUD, Clinical Imaging- Diagnostic Viewing, and Clinical Imaging Technologist Device requirements.

• Wireless Requirement Plan: Specifies wireless network infrastructure requirements for optimal wireless performance and redundancy.

• Forward Deployed Hardware List: Specifies the Racks, uninterruptible power supply (UPS), Power Distribution Unit (PDU) and power requirements for the data centers.

• General Infrastructure Requirements: Specifies capabilities for WAN, LAN, Wireless LAN, Space, Heating, Cooling, Power, EUDs, Physical security, VOIP and Medical Devices.

• LAN Equipment Deployment Plan: Specifies deployment plan for infrastructure to support connectivity to End-User Devices (EUDs), cabling, switches, routers).

Deployment plans are referenced in the Playbook. If additional plans are created, they will be incorporated into future revisions.

https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx#InplviewHash3fb85e3f-dd5d-4e50-a3f7-12fefbb70181=WebPartID%3D%7BAB7903DB--3A72--4674--8B68--9CFB62946312%7D

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Enterprise Level Oversight OEHRM Infrastructure Readiness will provide centralized enterprise-level oversight to develop an overall project plan specific to construction and infrastructure, that includes support and performance of schedule management activities:

• Reference the OEHRM Program Schedule and Cerner Integrated Master Schedule (IMS) that depicts the implementation timeline and dependencies for OIT and HEFP with a deployment schedule of the EHRM Project solution for sites.

• Manage the delivery of tasks and blockers through the OEHRM Infrastructure Tiger Team (ITT) that includes OEHRM, VHA and OIT for escalation, and task reviews.

• Develop an agile and holistic schedule that identifies project milestones, task durations, and highlights critical events and dependencies throughout the project lifecycle.

• Identify, track, and add additional sites as subsequent task orders are issued.

Tasks appropriate to the Enterprise will be conducted at that level. Required involvement of site engineers will be determined by HEFP, if this level support is necessary. Coordination for non-Enterprise level work to be made through the OSDT/Deployment Lead.

Enterprise program management will include and leverage: OEHRM Risk Management-Infrastructure Readiness Plan and Roadmap, Schedule Management, Communication Plans and Tools and Stakeholder Management. These documents will serve as a roadmap for the stakeholders to provide IT and physical infrastructure, training space and future-state equipment for site activation of the Cerner EHR. OEHRM Infrastructure Readiness will provide updates to the stakeholder tools to sustain and support infrastructure upgrades to the electronic health record system.

The Site Implementation Plan (SIP) will include durations and dependencies that are sites-specific.

Documentations will also describe Points of Contact (POC) and OEHRM/OIT/VHA collaboration that include requirements and action item tracking. This plan will be created as a site-specific guideline. Site Implementation Plans will include:

• Site Acceptance Test Plan.

• Training Space Approach.

• Facility and IT Infrastructure Readiness Dates.

The following documents will guide development of a Site Implementation Plan that provides:

• Deliverables with scheduled due dates.

• Deployment review.

• Schedule and action item reviews.

• Baseline Plan: Planned vs. Actual Timeline.

Site Level infrastructure schedule, with input from OEHRM, OIT and VHA will be provided for each Site. A Program level determination will stipulate what Project level site specific documentation is required.

https://dvagov.sharepoint.com/sites/VACO.OEHRMoffice/Misc/SitePages/Construction_Admn.aspx

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Risk Management The OEHRM Risk Management process is described on the OEHRM SharePoint page:

https://vaww.vashare.oit.va.gov/sites/ehrm/CTO/SitePages/Home.aspx.

Access to program level risks cannot be provided outside of the project. When specific site level risks are required, please contact your representative to the ITT to obtain a static copy of the risk register.

Risk Mitigation Strategy Risks are managed by the affected individual VA office, including VHA, OIT and OEHRM. Risks that an office believes should be elevated within the project, or to other entities, are identified in the Weekly ITT meeting. When consensus is made that the risk scope is project wide, it will be tracked on the OEHRM Risk Register.

• The ITT meeting with OEHRM, OIT and VHA will serve as the integration group to report on OEHRM risks.

• Risk Managers from VHA, OIT and OTI will facilitate risk identification in collaboration with OEHRM Risk Management.

Schedule and Milestones Management VHA will coordinate with OEHRM to provide a schedule of all acquisitions, including Procurement, Design, and Construction. OIT will coordinate with OEHRM for “what and when” is required for procurements. OEHRM will provide funding approvals and execute procurements (Appendix H). The Infrastructure Readiness project IMS will be iterative and continually updated as additional task orders are issued, task order required plans are approved and submitted, and other information is received from VA.

4.3.1 Milestones Management

• A progression dashboard will be available to show status of construction and IT infrastructure activities and a Microsoft Project file to display the sequence of activities and dependencies.

• OIT Infrastructure “Long Lead Milestone Tracking” can be found in Appendix H.

The IMS will be available in Project Web Application (PWA) for stakeholders to view. For access to OEHRM PWA, please contact James Babe at james.babe@va.gov.OEHRM will structure an IMS that includes Key Milestones from Cerner, OIT and other Enterprise Level entities. Schedule milestone management will be reviewed by the stated stakeholders. Changes to organizational schedules and milestones will be incorporated into the Cerner IMS and coordinated with the OEHRM Program IMS.

Communications Plan and Tools The communication plan will facilitate the interaction flow among all project stakeholders. Topic areas will include the target audience, communication owner, method and frequency of communications.

The key stakeholders’ roles and responsibilities, title and site location will be identified.

https://vaww.vashare.oit.va.gov/sites/ehrm/CTO/SitePages/Home.aspx mailto:james.babe@va.gov

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Email is the primary communications method. It is used for both formal and informal communications.

Email is the preferred method for formal or official communications. Program policy details procedures for sending official and sensitive information to non-VA email accounts.

Various communication tools by OEHRM, OIT and VHA and are described in the following table:

Table 2: OEHRM-VHA-OIT Communication Tools

Organization Communication Tool Purpose

OEHRM (TIO and CMO)

OEHRM Construction & Infrastructure SharePoint

Construction project status, signed deliverables progress, questions and completed related work

Telecommunication Room Updates

Telecoms room status and progress

Implementation Guide Overall deployment guide for sites [Note: This Guide is being developed and can be linked when complete.]

VHA Project Tracking Tool (PTR) Design and Construction Contract Status

HEFP SharePoint Site Self-Assessment Gap Analysis

OIT

Scrum of Scrums: Status of EHRM Integration Issues

Project leads to provide project status, progress and roadblocks

OTI Weekly Activity Report Weekly meeting with OTI Executive Director for briefing CIO and TIO Director

OEHRM/OIT/VHA/Cerner

ITT Weekly Meeting

Collaborative meeting with the organizations to optimize Construction and IT Infrastructure capabilities to support the implementation of the Cerner EHR system functions

Progression Dashboard Reporting tool for status of construction and IT infrastructure activities

A documented communication approach is needed for the EHRM implementation phases.

Communication tools ensure that all parties understand the OEHRM program, benefits and impacts.

These provide the information needed to complete required action items, report program progression, how to find information, post questions and prepare for Go-Live.

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Stakeholder Management Process Stakeholder management is the systematic identification, analysis, planning and implementation of actions designed to engage with stakeholders by defining the requirements, processes, and techniques for engaging stakeholders based on an analysis of their needs, interests, and abilities to impact the project. The Stakeholder Management process is like a communication plan. Stakeholder’s Organization with roles and responsibilities can be found in Appendix C: “Roles and Responsibilities”.

Budget: Acquisitions and Procurement VA OEHRM Acquisitions Management is charged with developing and executing the program’s acquisition policy and strategy and ensuring contract awards for the modernized EHR solution. OEHRM ensures that its funding is appropriated in coordination with OIT, VHA, and other organizations. OEHRM Contracting and Task Order development activities include collaboration and engagement with all program stakeholders including VA and OEHRM leadership, program managers and subject matter experts, EHR solution providers, and the Technical Acquisition Center.

Completion of assessments performed by OEHRM, OIT and VHA provide the necessary improvements required to comply with building project requirements and infrastructure projects. Each entity has a funding process to initiate acquisitions and procurement and components needed that is outlined in this section.

4.6.1 Funding Profiles and Organization Process

Funding profiles and corresponding acquisition processes based upon organizational need are outlined in the following table.

Table 3: Funding Profiles and Acquisition Processes

Organization Funding Profile Process

OEHRM (TIO and CMO) OEHRM Funds

Investments in support of TIO or CMO are conducted through the OEHRM acquisitions and procurements process; these funds can be used on VHA and OIT projects but not on Capital (construction) projects

VHA

VHA Medical Facilities Funds and Non-Recurring Maintenance (NRM)

Non-recurring maintenance activities are submitted for approval through the Strategic Capital Investment Plan (SCIP) process

OIT (IT

Operations and Services [ITOPS])

FY19 OEHRM Funds FY20 OIT/OEHRM Funds

OIT projects primarily leverage the Infrastructure Readiness Plan for available funding to support EHRM

Cerner OEHRM Funds Cerner contracts are managed through the OEHRM acquisitions and procurements process

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4.6.2 OEHRM Investment Justification Package (IJP)

OEHRM (specifically TIO and CMO): Investments in support of TIO or CMO are conducted through the OEHRM acquisitions and procurements process; these funds can be used on VHA and OIT projects but not on Capital (construction) projects.

The Office of Electronic Health Record Modernization (OEHRM) has created the Investment Justification Process (IJP) to manage approval of funding requests. The IJP documents the contract action being funded and provides justification for using OEHRM funds. These funds per statute cannot be used for capital improvements. OEHRM Funds for the Cerner contracts are also managed through the OEHRM acquisitions and procurements process.

To facilitate funding, the IJP process flow available to OEHRM stakeholders on the OEHRM SharePoint page, describes the TIO process for execution of an IJP.

4.6.3 OEHRM Funding and OIT Projects

OIT projects primarily leverage the Veterans-Focused Integration Process (VIP) and must be submitted through a VIP Request (VIPR). OEHRM is responsible for funding the augmentation of OIT staffing resources necessary to complete Increment 1 (EUDs, Joint Security Architecture (JSA), Microsoft Windows 10 (WIN10), LAN, WAN, WLAN, and printer upgrades) by leveraging new contract resources, to support transition activities. ITOPS applies augmentation gap support to close personnel gaps, ensuring timely completion of site transitions. (Source: EHRM Integration Infrastructure Plan, November 2018).

4.6.4 VHA SCIP/ Drives Resources Augmentation Requirements

OEHRM will work with HEFP to determine which upgrades will be procured throughout the building projects, including best practice on acquisition strategies from previous deployments. Based on assessment findings, the scope and timeline of the procurements can vary widely.

The SCIP will outline responsibilities for soliciting offers, negotiation, development, award, oversight, modifications and closeout of any contracts that are entered on behalf of the government for their organization. VHA will work with legal to make sure all contracts and agreements adhere to federal and VHA policy and regulations.

Non-Recurring Maintenance (NRM) are maintenance activities submitted for approval that require augmentation for staff resources. These are necessary to support new technical knowledge requirements and satisfy the frequency and speed for infrastructure delivery. Two major constraints to be satisfied through the Strategic Capital Investment staffing augmentation are technical knowledge gap, and timeline. This increase in workload scope goes beyond industry standard planning (e.g., 20% technical equipment refreshes). Technology knowledge gap, which staff does not readily possess the skill set. (Source: Productivity Surge Plan (SCIP) process) Procurement follows the SCIP process. The SCIP process includes all capital projects (major/minor construction, non-recurring maintenance (NRM), and leases) except for information technology non-

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RACI Matrix: Organizational Expectations In conjunction with the identified communication tools, the RACI matrix will be used to outline organizational expectations based upon infrastructure requirements from an enterprise level. A RACI matrix helps set clear expectations about project roles and responsibilities. There is a distinction between a role and individually identified person. A role is a descriptor of an associated set of tasks which may be performed by many people. In contrast, one person can perform many roles.

The RACI developed by OEHRM and entities will specify one (or more) of the following per requirement:

• Responsible (R) – Assigned to complete the activities/artifacts associated with the integration area. Additional team members may be assigned. Each task must have someone responsible.

• Accountable (A) – Has ownership of the result and process; final decision-making authority and accountability for activities/artifacts associated with the integration area. There is only one Accountable person assigned to each task or deliverable.

• Consulted (C) – Is involved throughout by providing input or knowledge and information; could be an adviser, stakeholder, or subject matter expert for an integration area. Consulted parties typically provide input based on either how their future project work is impacted or domain expertise for the deliverable

• Informed (I) – Receives information and must be informed about integration activities.

• Capital – Building improvements managed by VHA.

• Non-Capital – IT improvements managed by OEHRM and OIT.

• Funding – OEHRM’s budget funds improvements for equipment and patch cables.

Tasks shown are associated with VHA Building/Facility and IT Infrastructure. These are the elements necessary to upgrade the building infrastructure to prepare for EHR deployment or "Go-Live". Typical improvements would include telecommunications closet upgrades (e.g., Power, Cabling, HVAC), server room upgrades, etc. Office of Management and Budget (OMB) would refer to these as the Real Property components and improvements funded out of NRM. IT Infrastructure represents OIT projects and IT activities needed to support the technical aspects for site activation. This RACI Matrix is valid for activities for pre-Go Live Infrastructure Readiness activities and the Post Go Live RACI will be developed as part of the Sustainment Guide.

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Capital – Building projects/improvements managed by VHA, as shown in the following RACI Diagram:

Table 4: OEHRM RACI: Capital-Building Projects and Construction Improvements

CAPITAL

Area Task

VHA OEHRM OIT

HE

FP

VI

SN

VA

M

C

P&

LO

TI

O

CM

IT

PS

Building Infrastructure Readiness

Determine Pre-Planning Activities A R R C C I C

Execution of Plans A R R R I I C

Conduct Validation/Testing A R R I R I C

Building Infrastructure Assessment

Develop EHRM Infrastructure Requirements R C C I A C C

Conduct EHRM Readiness Infrastructure Self- Assessment Checklist (VHA/OIT TRs and DCs)

A R R I C C C

Publish Enterprise Self- Assessment Schedule A R R C I C C

Identify and Document Physical Assessment and Gap Analysis

A R R I C C C

Determine Cost Estimation A R R I I I C

Prepare Budget and Submission A R R I I I

Project Development (Non- Recurring Maintenance)

Identify Gap Integration and Project Scope Definition A R R C C

Conduct Submission of Project Plan (SCIP) A R R C I

Identify and Document Physical Assessment and Gap Analysis

A R R I C

Determine Cost Estimation A R R I I

Prepare Budget and Submission A R R I I

Physical Security and Space

Determine Physical Security Components R A C I I C

Wall penetration, conduit and asbestos remediation A R R R C

HVAC Identify Additional BTU cooling for Cerner Equipment R A C I I I

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CAPITAL

Area Task

VHA OEHRM OIT

C

Power

Provide Power for Cerner Equipment R A C I I I

Provide Uninterrupted Power Supply R A C I I I

Provide Emergency Backup Power R A C I I I

Single Point Facilities Grounding R A C I I I

Determine Main Facility Power Feed R A C I I I

LAN (Network)

Installation and Maintenance of Network Cables in Walls A R R C I I I

Installation and Maintenance of Fiber Backbone and distribution

A R R C I I I

EUD

Installation of Data Drops, Power outlets, and Wall mounts

A R R R I I C

Project Execution (Non- Recurring Maintenance)

Determine Design Procurement Strategy A R R R I

Review Design (Architect/Engineer) A R R R C C

Determine Construction Procurement Strategy A R R R I

Perform Construction Period of Performance A R R R I

Ongoing Risk Identification and Reporting A R R C C

Conduct Routine and Ad-Hoc Reporting A R R C I I I

Conduct Readiness Status and Project Reporting A R R I I I I

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Non-Capital is defined as OIT projects/upgrades managed by OEHRM and OIT, as seen in the following RACI Diagram:

Table 5: OEHRM RACI: Noncapital-OIT Projects AND IT Infrastructure Upgrades

NON-CAPITAL

Area Task

VHA OEHRM OIT

C

WAN

(Network)

Assess Interface Availability I C I I A, R Assess Circuit Monitoring (bandwidth/utilization)

I C I I A, R

Design (Redundancy) I C I I A, R Obtain Funding for LAN/WAN/ WLAN Refresh

A, R C C

LAN (Network)

Define Patching Cable Requirements

I I I I A, R C C

Provide Funding and Determine Procurement Strategy

I I A, R C C

Supplying of Network Patch Cables I I A, R I I C

Supplying of Network Switches I A, R I I C

Installation of Network Patch Cables and Switches

I I I I A I R

Assessments of LAN switches end of life Refresh

I A, R

Provide Environmental Central Monitoring in Telecom Rooms

A R R C I I C

Build the LAN Topology Design I C I I A, R

WLAN

(Network)

VA Wireless Design, Equipment and Operation

I C I I A, R

Determine PoE to access point C I I A, R

Install Network Cable to access point

A C I I R

EUD and Peripherals

Obtain Funding for EUDs and Deployment Support

I A, R I C C

Acquire EUDs A, R I I C

Installation and Deployment of EUD and peripherals

I I A, R

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NON-CAPITAL

Area Task

VHA OEHRM OIT

C

Medical Devices

Procurement of Medical Devices R A R R R C C I

Installation of Cerner Bio- Medical Devices

R A R R I I C

Cerner supplied connectivity engines (CCE)

Procure CCE I I I I A, R I

Install CCE R A R I I I

VOIP

Determine Gigabit Data Rate pass through to EUD

I C I I A, R

Obtain Funding for VoIP A, R I C C

Cerner Go Live Help Desk

Incident and Problem Ticket Reporting

A, R I

Provide space to support Go Live A R R R I C I I

National ACD Configuration C C I R

Provide GFE and network to support the Help Desk

A, R I I R

Obtain PIV card for Cerner Help Desk staff

A, R C I C

VA Enterprise Service Desk

(ESD)

Fund and Implement Remedy Interface to ServiceNow

C A, R I I C

Implement ACD Configuration C I A, R

IVR Configuration / Call Routing I I I A, R

Millennium Service Desk (Post Go Live)

Incident and Problem Ticket Reporting

A, R I I I

Develop Standard Operating Procedures

I I A, R C I C

Acquire Help Desk Staffing A, R I C C

Provide Knowledge Documents R C I C

Training Space*

Installation of Monitors/Teleconferencing

I I IR I A, R I I RC

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NON-CAPITAL

Area Task

VHA OEHRM OIT

C

Obtain Funding for VA Workstation PC/Monitor/Keyboard/Mouse and installation

I I I I A, R I C C

Installation of VA Printers I I I I C I I A, R

Installation of Projectors I I I I A, R I C

Breakroom/Microwave/Refrigerator I I A R C I

Provide space for Training A R R R I C I I

Command Center *

Installation of Monitors/Teleconferencing

I I I I A, R I I R

Obtain Funding for VA Workstation PC/Monitor/Keyboard/Mouse and installation

I I I I A, R I C C

Installation of VA Printers I I I I C I I A, R

Installation of Projectors I I I I A, R I C

Breakroom/Microwave/Refrigerator I I A R C I

Provide space for Command Center A R R R I C I I

Fund and Procure VoIP and telephony supply and cable

R R R R A, R I I I

Cloud ** Provide and operate VA enterprise Cloud

Consider hosting of any VA

* For facilities that are not at the VAMC/VSN, the OEHRM Infrastructure Readiness RACI will need to be adjusted ** Cloud Strategy and Approach will be defined in the Sustainment Guide

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Facility Infrastructure Planning VHA will guide the facility with planning activities to initiate the Building (Construction) Projects. VHA HEFP and OEHRM will work with the facility to provide planning documents covering infrastructure improvements, facilities funding and contracts determination and acceptance of work. VHA has developed a Facility-specific planning process to monitor and control activities between site and enterprise infrastructure components. Documentation created during the Planning Phase will be used to complete the facilities upgrade tasks in subsequent project phases and serve as a roadmap for site implementations. These efforts are going to begin two years before go-live, pending a more detailed schedule.

Kickoff The new EHR solution is designed to accommodate various aspects of health care delivery that are unique to Veterans and VA. The OEHRM implementation is scheduled to take several years to be fully complete and will continue to evolve with technological advances that incorporate industry best practices.

The Facilities Infrastructure Kickoff Meeting is organized by the HEFP team to plan the facility upgrades required to meet EHRM deployment needs. It will also provide an overview of the site deployment process to include the following associated tasks and roles:

• The Kickoff will be held at an agreed upon date, time and location, with a possibility for remote meeting.

• Project Background and Overview.

• Site Infrastructure Requirements.

• Project Scoping.

• Issues/Risks/Questions/Concerns.

• Next Steps and Timelines.

Facility Assessments To compare OEHRM Infrastructure Requirements that support the new EHR system, current state infrastructure must be assessed by conducting “As-Is” analysis. The purpose of the “As-Is” analysis is to identify infrastructure deficiencies at VAMC’s, CBOC, Vet Center and other off-site facilities; the scope of construction and facility needed for Go-Live include:

• Space: Data Center, Telecommunication Room (TR), MDAs and cabinets/racks.

• Electrical: Facility power circuits, UPS and Emergency generator; Temperature: HVAC, active monitoring of Data Center, TRs Cabling: Fiber, Ethernet twisted pair category.

• Patch Panels: TRs Data Centers.

• Circuits: WAN connection all locations (VAMC, CBOC, VET Centers, supporting sites call centers).

• Gateway: WAN router, WAN Accelerators.

• JSA Security Stacks, FDSS, DMLSS.

• Fiber Backbone: Campus building to building, intrabuilding.

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• LAN/WLAN.

OEHRM, VHA, and OIT created a self-assessment plan to perform a review of all TR rooms, with attention paid to determining if the ethernet cabling, power over ethernet (POE), other switch ports, power, cooling, monitoring, physical security, rack space and UPS hardware are adequate. Collaborative OIT/VHA technical staff will perform the survey and populate the survey template to inform the design process based on identified deficiencies.

There are several existing Facility Assessment/Design Plans and templates already in existence for networks, and desktops. Examples of the design manuals and requirements can be found for:

• Telecommunication and Special Telecommunication Systems

• Physical Security Design Manual

• Enterprise Local Area Network (LAN) Technical Architecture Standard

Examples of the design manual can be found on the Construction & Infrastructure SharePoint Site.

5.2.1 Site Self-Assessment

The site will perform a VHA led self-assessment to determine the current readiness for accepting and implementing the EHR. A comprehensive criterion must be followed in the self- assessment to show the preparation of the station for deployment. Several factors that judge the technical infrastructure readiness are critical, including:

• As-Is State of Data Centers, Telecommunication Room (TR), closet wiring, cabling, power, temperature, space and UPS.

• Updating hardware and software at VA facilities, including routers, servers, and telephony systems.

• Wi-Fi infrastructure with high-density, high-availability.

• Keeping VA Cloudsmart policy in mind when performing datacenter assessments.

This is an assessment of the technology environment and the infrastructure elasticity required to support new capabilities. The analysis of the current environment of IT infrastructure will guide the refresh and replacement of the infrastructure, using Cloudsmart as a guide where appropriate; results from the assessment of VA’s IT operations will allow for VA to analyze deficiencies and provide efficient and modern telecommunications and infrastructure technology solutions, with enhanced hardware and software capable of integrating with newly adopted solutions.

5.2.2 Cerner Current State Review (CSR)

It is critical to understand that while all sites are implementing the same standard solutions, each site is at a different starting point.

A Current State Review (CSR) evaluates and documents the As-Is state of the technical environment. It is compared against OEHRM deployment requirements to inform site modifications and assess technical readiness. This helps determine how the new EHR will be implemented for various departments within a site. The partnership team and assigned site personnel are co-located at the facility to conduct a series of current-state events.

https://vaww.vashare.oit.va.gov/sites/ehrm/CTO/InfrastructureandNetworking/Construction%20Documents/Telecommunications%20Systems%20Design%20Manual.pdf https://vaww.vashare.oit.va.gov/sites/ehrm/CTO/InfrastructureandNetworking/Shared%20Documents/Enterprise%20Local%20Area%20Network%20(LAN)%20Technical%20Architecture%20Standard_v2.1.docx?Web=1

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To understand each site’s current-state processes, Cerner project managers meet with site departmental SMEs. They review the current workflows and organization of clinical, financial, business administration, ancillary and technology departments.

Understanding the facility current-state operations will help ensure personnel are aware of existing service lines and locations within a site. Furthermore, this understanding can identify potential risks or unique areas where standards need to be established. It will also aid in outlining the adoption strategy and how the team needs to approach certain areas where process change can vary from a little to dramatic. CSR Deliverables will be shared with the assessed facility once completed and can also be requested by contacting OEHRMIR@va.gov once officially approved by OEHRM.

5.2.2.1 Closet Assessment

Included in the CSR is a survey of the facility infrastructure. Given the variance of timing for the CSR as it relates to the SSA, Cerner’s closet survey will act as either a confirmation on the accuracy of the SSA, confirmation of the upgrades performed in the capital improvement process or a mix of both.

Cerner will provide a draft of their closet assessment before submitting the full CSR. OEHRM will coordinate the analysis of the assessment, including comparing it to VHA’s previously performed Site Self-Assessment. Any discrepancies will be shared, reviewed and resolved between OEHRM, HEFP and Cerner before the final draft of the assessment is distributed by Cerner or submitted as complete. The review and comparison will need to be performed in the same week it is shared due to the time sensitive nature of the CSR submissions by Cerner.

5.2.2.2 Future State Equipment

During the CSR, Cerner will perform a facility walkthrough to determine the placement of new equipment and hardware, such as display boards, monitors and workstations, printers, and scanners. An outcome of the CSR is the Debrief and report will be shared with the local site. A SharePoint link will not be provided in the CSR but can be shared upon request.

The CSR debrief will outline future state equipment and detail the building infrastructure required to support hardware (e.g., additional power and data drop installation).

HEFP will be engaged to perform the building infrastructure upgrades. This action will be sequenced with the VHA SCIP process for capital projects.

5.2.3 Review Assessments to Define Scope of Construction Projects The completed self-assessment of As-Is state, as well as any other assessments performed by VHA will provide the necessary scope to comply with project requirements. The assessments are meant to show facility deficiencies that need remediation to meet OEHRM site requirements. This scope will range from upgrading server and telecommunication rooms, to building infrastructure such as campus fiber.

Facility Enterprise Design The Facility Assessment & Design Phase will address upgrade tasks for their subsequent project phases for building improvements/projects to be initiated. Existing infrastructure must be assessed to provide OEHRM fully executed Infrastructure requirements established in support of the EHR initiative. This assessment requires a gap analysis between “As-Is” and “To-Be” states to determine what must be mailto:OEHRMIR@va.gov

V2.0 OEHRM Infrastructure Readiness Playbook (iPlaybook)| 22 upgraded to meet project infrastructure requirements. The upgrade process entails analyzing the survey information to determine deficiencies, provide procurements to acquire design and construction services and equipment. This will result in a series of procurements to provide upgrades for implementation in the Pre-Deployment Phase.

Design and Construction of building improvements should be initiated in accordance with Appendix H:

Long Lead milestones Tracking, when this is not possible all parties will work to determine the alternatives and way ahead. The assessments meeting objective will be to introduce planned assessments. This includes a site self-assessment to As-Is state to allow visibility into the process of assessing strengths and areas in need of building improvement, identifying discrepancies of performance and a forum for the technical team to set assessment expectations.

Facility Training Space OEHRM, HEFP, OIT, and the local facility will determine the most effective method for providing adequate training space to meet Cerner requirements.

The following items should be taken into consideration when determining the most effective method:

• If the training space can be accommodated without construction in existing VAMC facilities for the required training and other operations, that is the preferable option.

• If the training space can be accommodated in existing VAMC facilities, but design and/or construction work is needed, EHRM Non-Recurring Maintenance monies will be used to fund procurement through VHA and associated Contracting partners such as NCO or PCAC.

Requirements must be provided to VHA with enough lead time to procure the design and construction. If design and construction are required, VHA needs requirements 20 months prior to activation of training space. Simple renovations that do not require design, but only construction, can be accomplished in 12 months.

• OIT needs training requirements 6 months prior to initial use of the training space.

• If the training space cannot be accommodated in existing VAMC facilities, then the following options may be considered:

Leased modular facilities: VHA will do exterior site prep; for example, level site, bring utilities to site, but is not responsible for modifications to Cerner interior leased spaces. Cerner shall include interior modifications as part of their modular unit/trailer lease.

GSA space: VHA will enter into an Occupancy Agreement and execute a Reimbursable Work Authorization with GSA to prepare the space, as needed to meet training requirements.

A combination of leased, VAMC, and GSA space may be appropriate based on the site logistics capabilities.

A high-level view of information to be gathered from Cerner is provided in Appendix H: Long Lead milestones Tracking, and IT infrastructure requirements are outlined in the OIT project section.

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IT Infrastructure Planning Pre-Deployment outlines activities for IT infrastructure, this is the means to identify infrastructure installations and sequence of operations (or steps). These must be conducted to deliver changes to the system environment.

Modernization of VA's IT systems supports planned increased capabilities. Modernization should account for the Cloudsmart strategy leveraging the VA Enterprise Cloud (VAEC). Efficient and modern infrastructure technology will need to be in place for the enhanced hardware and software for the new EHR solution. The IT infrastructure must be stable for at least six months prior to operations such as WAN Core Switch and MACD upgrades, VoIP Phones for desktop support and additional components that will all need to be racked, stacked, configured and testing of all equipment that will be deployed.

Appendix H: Long Lead Milestones Tracking outlines the required infrastructure readiness requirement timelines for major milestones.

Infrastructure Installation Installation of IT infrastructure related upgrades are required during this phase, which includes assistance from OIT, FMS, and Cerner. This includes installations and upgrades that are outlined in the OEHRM Infrastructure Requirements.

6.1.1 Physical Infrastructure Upgrades

This section shows the list of physical infrastructure upgrades that will need to be completed during the pre-deployment phase to support the rollout of EHR. For more details on the component of the upgrades, refer to the Site Infrastructure Requirements on the Construction & Infrastructure SharePoint site.

• Additional Space and Power.

• Additional Cooling in Data Center and TR to Support New Equipment.

• UPS and Emergency Generator Upgrade.

• LAN/WAN Network Upgrade.

Necessary space and power for core switch upgrades will be managed by local engineering with input and agreement from the core organizations. If they are unable to develop a solution, it should be elevated to the HEFP Director of Special Projects for resolution.

• Network Cable and Fiber Upgrade.

• Physical Security Upgraded to Meet VA Standards.

• Telecommunication Room and Data Center Upgrades Complete for Go-Live.

For site coordination issues that do not fall under HEFP’s construction umbrella, OEHRM will work with the local Technical Lead. This individual, as part of OEHRM’s site presence, can bring these reporting and coordination issues to the OEHRM Site Deployment Lead. This is a local site employee who has been detailed to OEHRM to oversee/manage deployment.

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Cerner-Provided EHR Planning Cerner will provide infrastructure equipment to support EHR Implementation. This infrastructure equipment will be in VAMC Data Centers.

6.2.1 Forward Deployed Service Server (FDSS) Installation

The current Cerner hosting environment is a DoD security enclave, known as the Federal enclave. VA is implementing a Joint Security Architecture (JSA) at facilities that meet the criteria identified above.

Network connections will be required to interface between the VA Network, and Federal enclave. FDSS will be supplied in dedicated racks and be redundantly powered. Security stacks will receive connectivity through the JSA architecture outlined in Section 6 “IT Infrastructure Planning”.

Cerner will also provide forward deployed servers to be hosted in the medical server room and retain ownership, operation and maintenance. Delivery and placement of populated racks is Cerner’s responsibility. Cerner will coordinate this action with the site. This includes rack transport and installment without damage to the equipment, facility or datacenter. The Cerner provided equipment will include two redundant “top of rack” mounted switches to support the components in each rack;

updates to operations of the top of rack switches will be managed by Cerner [Note: Further information for T-o-R updates will be added in subsequent iPlaybook updates]. These top of rack switches become part of the JSA architecture managed by DHA. Cerner has full responsibility of on-going operations and maintenance of these servers under OEHRM contract.

An active Authority to Operate (ATO) is required prior to system operation. OEHRM is the system owner of the FDSS.

Network Infrastructure Network infrastructure will be upgraded if needed to support Cerner EHR. Based on the conducted assessments, the infrastructure will be upgraded for WAN bandwidth, network…