Do D VA INTERAGENCY PROGRAM OFFICE INDUSTRY DAY i

Do. D/VA INTERAGENCY PROGRAM OFFICE INDUSTRY DAY i. EHR Pharmacy Tuesday, 14 August 2012

INTERAGENCY PROGRAM OFFICE Administrative Announcements Anne Marie Vasconcelos, Acting Division Chief

Administrative Announcements 4 Please sign-in and wear your name tag 4 Ask Questions – Cards available at sign-in desk and around the room – Please put the topic that the question is directed to on the top of the index card – Hand to Government personnel throughout the day – Questions will be answered and posted to the Federal Business Opportunities (Fed. Biz. Opps)Page (www. fbo. gov). This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 3

Administrative Announcements 4 Please put electronic devices in silent mode 4 Restrooms are located in the lobby 4 There is no smoking inside the Sheraton 4 Information presented during this briefing represents the latest information This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 4

Administrative Announcements 4 A released formal Solicitation shall take precedence over and dictate all contractual requirements beyond this event and this briefing 4 Any further questions/comments related to these programs shall be submitted in writing to the Contracting Officer 4 Government may provide responses to questions during this briefing. Additional questions and responses will be posted on the Fed. Biz. Opps page This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 5

Administrative Announcements 4 All presentations and responses to questions are considered ADVISORY only and may be subject to change without notice in any formal solicitation. 4 No proprietary information is being solicited/requested or provided during this event This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 6

One-on-One Sessions Any vendor who has requested a One-on-One Session, and will be unable to attend, please notify the Registration Table immediately. It is requested that vendors enter through the main MITRE Building entrance located at the back of the building. Those vendors with One-on-One sessions from 4: 30 PM on, should enter the side entrance by CDW. A Government representative will escort you to your meeting room. This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 7

INDUSTRY DAY AGENDA 48: 00 -8: 15 am Welcome and Opening Remarks Presented by: Patrick Shannon and Keith Tietmeyer, Co-Program Managers, i. EHR Pharmacy 48: 15 -8: 45 am Interagency Program Office and i. EHR Overview Presented by: Barclay P. Butler, Ph. D. , Director, Do. D/VA Interagency Program Office 48: 45 -9: 00 am Acquisition Schedule and Overview Presented by: Mark Junda Contracting Officer, VA Technology Acquisition Center 49: 00 -10: 00 am i. EHR Pharmacy Overview Presented by: Lu. Anne Barron (Program Manager, Pharmacy Reengineering/Clinical Informatics/Pharmacy Benefits Management) and Henry Gibbs (Director, Do. D Pharmacy Informatics/TRICARE Management Activity Pharmaceutical Operations Directorate) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 8

INDUSTRY DAY AGENDA 410: 00 -10: 15 am Break 410: 15 -11: 15 am i. EHR Technical Specifications Package Overview Presented by: CAPT Hung Trinh (Technical Lead, i. EHR Pharmacy) 411: 15 -11: 45 pm i. EHR Pharmacy Request for Information Presented by: Patrick Shannon and Keith Tietmeyer 411: 45 -12: 00 pm Closing Remarks Presented by: Mark Junda This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 9

INTERAGENCY PROGRAM OFFICE Interagency Program Office and i. EHR Overview Barclay P. Butler, Ph. D. , Director, Do. D/VA Interagency Program Office

MISSION, SCOPE, OBJECTIVES This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 11

Summary of IPO Charter: Signed October 27, 2011 • The IPO serves as the single point of accountability for the Departments in the development and implementation of • the integrated electronic health record (i. EHR) and • Virtual Lifetime Electronic Record (VLER) Health systems, capabilities, and initiatives with the goal of full interoperability between the Do. D and VA. • all interagency activities related to the i. EHR and VLER Health Programs - lead, oversee and manage. • Tasks include – Planning – Programming and budgeting – Infrastructure Requirements and Funding – Contracting – Common Services – Architecture – Implementation – Capability Acquisition and Development – Sustainment – Data Strategy and Management – Testing and Evaluation Planning This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 12

What We Do: IPO Major Initiatives Integrated Electronic Health Record (i. EHR) • • Joint Do. D-VA program to modernize legacy EHR capabilities and create a single common health record throughout the continuum of care and life of a patient Will replace Do. D’s AHLTA and VA’s Vist. A systems Virtual Lifetime Electronic Record (VLER) Health • • • White House initiative to exchange data between Do. D, VA, other Federal agencies, and private providers based on national standards – Will enable comprehensive health, benefits, and administrative information, including personnel records and military history records Four joint Do. D-VA pilots demonstrated exchange of health data in San Diego, Tidewater, Spokane, and Puget Sound, 12 VA locations IPO will focus its efforts on the VLER Health (health data exchange) for clinical treatment Oversight Mission JALFHCC • Five-year demonstration project is the first integrated facility of its kind, serving both Do. D and VA populations • The North Chicago Veterans Affairs Medical Center and the Naval Health Clinic Great Lakes merged to become the Captain James A. Lovell Federal Health Care Center on This document contains Booz Allen Hamilton Inc. proprietary and October 1, 2010 Delivery of Seamless Health Care and Benefits confidential information and is intended solely for internal use. 13

i. EHR System Vision Current State Fulfillment Hospital Direct Care Staff Admin IOC: FY 14 – Incremental Convergence Patient Fulfillment Hospital Direct Care Staff Admin Patient Target: FY 15+ – Enterprise Enabled Fulfillment Hospital Direct Care Staff Admin Patient User Experience Business Processes System Exchange Unique Business Processes (Organization and Site-specific): VA-Do. D / VAMC-VAMC / MTF-MTF Adhoc, Primarily Messaging Harmonized Workflows: San Antonio & Hampton Roads Unified Workflows Portal, Messaging, and Service Frameworks, Client Interfaces through common core services Systems & Infrastructur e Organization-specific Capabilities, Numerous Disparate Systems, Platforms & Software Baselines Common Infrastructure Foundation Core Services (Id. M, Access Control) Data Numerous Unique Data Models, Stores, & Applications Single Logical Data Store (Federated) Multiple Physical Data Stores (Vist. A, CDR, HDR) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Longitudinal Patient Record Delivery of Seamless Health Care and Benefits 14

This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits

i. EHR Initial Operating Capability (IOC) Require Components in All Layers of Architecture to Realize a Clinical Capability Delivery of Seamless Health Care and Benefits This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 16

SCHEDULE This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 17

i. EHR Functional Capabilities will be delivered incrementally using agile methods and will be based on This document contains Booz Allen Hamilton Inc. proprietary and Functional Priority, Technical Delivery of Seamless Health Care and Benefits Feasibility, and Financial Viability confidential information and is intended solely for internal use. 18

i. EHR Development Increments This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 19

Agile Development & The Agile Manifesto We have come to value… Agile over Waterfall Individuals and Interactions over Processes and Tools Working Software over Comprehensive Documentation Customer Collaboration over Contract Negotiation Responding to Change over Following a Plan That is, while there is value in the items on the right, we value the items on the left more. Cost Time Requirements Fixed Agile Waterfall Estimated Requirements This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Time Cost Delivery of Seamless Health Care and Benefits 20

Agile Execution Process This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 21

Agile Roles and Responsibilities 4 Product Owner – Functional, Government Person – Embedded in the team – Decision maker • Reach back to C-IPTs 4 Product Manager – PM-like role – Focused on Release management – Overall 4 Scrum Master • End Users – Invited to Sprint Review – Asked to comment via survey tool – Data driven decisions • Use of Agile Management in – Facilitator, Agile SME – SW Development – Assists process – COTS, GOTS, Open Source configuration – Integration/Interoperability This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 22

Agile Scrum Clinical Governance HEC DOD/VA Business Sponsors ICIB Co-Chairs Integration with other SMEs (e. g. technical, data) Do. D & VA Capability Business Owners Product Owner This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Product Owner Delivery of Seamless Health Care and Benefits 23 23

Agile in the Enterprise Leffingwell, D. (2011). Agile software requirements: Lean requirements practices for teams, programs, and the enterprise. Boston: Pearson Education, Inc. This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits

Gated Agile – Joint Do. D and VA Acquisition Processes Phases Mileston es Phases PMAS: Project Mileston es BCL: Program The functional community is responsible for the Definition phase As new increments are defined, they will start (post Milestone A) Programs will execute several increments (1824 months) throughout the lifecycle Increment 1 Business Capability Definition Investment Prototypi Manageme ng nt Planning MDD: Program Start MS A N 2 3 Limited Deploymen t Transition & Deployment Engineering Development Design, Development, Integration & Test MS B MS C Project Proje Buy, Release Start Adopt, RFP ct Build Active Definition & Contract Award Planning IPO is responsible for IOC deployment (Alpha and Beta sites)*. Respective Departments are responsible for enterprise deployment Programs will have customer facing releases available for a defined set of users within every 6 months. Planning / Provisioning Projects may become Several projects will active at any point during be executing at the Design, Development, same time; the above Integration & Test phase shows an example of This document of the program (post milestones and contains Booz Allen Hamilton Inc. proprietary and Milestone B) once phases confidential information and is intended solely for internal use. for a single approved by the Program project IOC FDD Operations & Support Sustainment FOC Software Delivery 2 Delivery N 1 Closed: Complete Project Execution – Development and Test Active Projects will complete software deliveries within a Project Iteration for integration within an overall Program Seamless Delivery of release(s) Closed: Complete Health Care and Benefits * Note: With the exception of VLER Health which is responsible for enterprise deployment 25

` i. EHR - Presentation Layer Clinician View (Home Page) NOTE -- The health record depicted here contains sample test data used for demonstration purposes This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 26

i. EHR - Presentation Layer Clinician View (Patient Summary) NOTE -- The health record depicted here contains sample test data used for demonstration purposes This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 27

i. EHR - Presentation Layer Notional portal-based approach allows for portlet re-use NOTE -- The health record depicted here contains sample test data used for demonstration purposes This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 28

INTERAGENCY PROGRAM OFFICE Advanced Planning Brief to Industry Anne Marie Vasconcelos, Acting Division Chief August 14, 2012

Agenda 4 Acquisition Overview 4 Acquisition Strategy 4 Acquisition Timeline 4 Acquisition – Moving Forward This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 30

Acquisition Overview • Anticipate a hybrid FFP and CPFF contract • Licensing will be FFP • Services will be CPFF • Integration Support, PM Support, Installation/Configuration, Data Migration, etc. • Period of Performance structure • Base task with multiple optional tasks • Anticipate exceeding five years This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 31

Acquisition Strategy • Anticipate full and open competition released on Fed. Biz. Opps. • Best Value Source Selection • Technical Requirements • Technical Solution/Approach • Demonstrations • Veterans Involvement/Small Business • Price/Cost • Past Performance This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 32

Acquisition Timeline • November 2011 - Request for Information • February 2012 – Demonstrations at HIMSS Conference • June 2012 – Request for Information (Draft PWS, TSP) • August 14, 2012 – Industry Day • October 2012 – Pre-solicitation Conference • October 2012 – Solicitation • November 2012 – Proposals Due • March 2013 – Contract Award This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 33

Acquisition – Moving Forward • Continue to engage with industry • All questions must come through TAC • Mark Junda, Contracting Officer, Mark. junda@va. gov, 732. 578. 5428 • Michael Weckesser, Contract Specialist, Michael. weckesser@va. gov, 732. 578. 5496 • All updates through Fed. Biz. Opps This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 34

INTERAGENCY PROGRAM OFFICE i. EHR Pharmacy Overview Lu. Anne Barron Henry Gibbs

Overview 4 i. EHR Pharmacy Background 4 Goals, Objectives and Outcome Measures 4 i. EHR Pharmacy Requirements (Overview) 4 i. EHR Pharmacy Business Process Models This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 36

i. EHR Pharmacy Background 4 In December 2010, the Deputy Secretaries of Do. D and VA directed the development of an integrated Electronic Health Record (i. EHR) – Provide both Departments an opportunity to reduce costs and improve interoperability and connectivity. 4 Do. D and VA leadership selected Pharmacy to be the first capability to be developed under the i. EHR initiative. – First i. EHR Pharmacy site James A. Lovell Federal Health Care Center (JALFHCC) in North Chicago 4 A joint Pharmacy system would be the first step in modernizing/replacing the existing Do. D clinical system, Composite Health Care System (CHCS), and the VA Pharmacy Modules within Veterans Health Information Systems and Technology Architecture (Vist. A) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 37

i. EHR Pharmacy Background (cont. ) 4 Do. D and VA pharmacy functional subject matter experts (SMEs) were charged to identify joint business processes and requirements for inpatient pharmacy, outpatient pharmacy and pharmacy inventory management. 4 Utilizing business process re-engineering principles, the group was to identify efficiencies that can be gained by streamlining the process. 4 This enterprise wide system would improve clinical care by providing both Departments with the following: – A single solution to include uniform prescription and medication orders data – Improved patient safety for all beneficiaries – Pharmacy inventory management This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 38

i. EHR Pharmacy Background (cont. ) 4 April 2011 - Shared/presented Do. D and VA “As-Is” Processes – Inpatient pharmacy business processes – Outpatient pharmacy business processes – Inventory management processes 4 May 2011 - Developed/documented joint “To-Be” business processes and requirements – i. EHR Joint Pharmacy Process Model Summary Report – i. EHR Joint Pharmacy Requirements – Documented key process changes/ optimizations 4 Performed market research – November 2011 Published Request for Information (RFI) – February 2012 Vendor Demonstrations at HIMSS – May 2012 Published Request For Information (RFI) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 39

Goals, Objectives and Outcome Measures This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 40

i. EHR Pharmacy Scope 4 Provide the ability for a joint Do. D/VA pharmacy system to enable pharmaceutical services (e. g. , process medication orders and prescriptions) without any degradation to existing functionality. 4 Provide access to the patient’s full electronic health record for clinical decision support – management of duplicate orders – allergies – contraindications – dosage checks – drug-drug interaction checks during the processing, etc. 4 All orders received by the joint Do. D/VA pharmacy system will be available enterprise wide for medication therapy management. 4 Do. D/VA Enterprise Pharmacy Solution This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 41

i. EHR Pharmacy Scope (Do. D/VA Enterprise) 4 Population – Do. D 9. 7 million beneficiaries – VA 8. 51 million beneficiaries 4 Facilities – Do. D 56 hospitals, 363 medical clinics, and 282 dental clinics with over 500 pharmacy dispensing locations – VA 152 Hospitals, 133 Community Living Centers, 98 Domiciliary Programs, 981 Outpatient Clinics, 300 Vet Centers with over 200 pharmacy dispensing locations 4 Volume – Do. D Approximately 50 million Military Treatment Facilty (MTF) outpatient prescriptions annually – VA Approximately 140 million outpatient prescriptions annually • 32 million prescriptions filled at VA facilities • 108 million prescriptions filled at a Consolidated Mail Outpatient Pharmacy (CMOP) Delivery of Seamless Health Care and Benefits This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 42

i. EHR Pharmacy Requirements Overview 4 Common i. EHR Medication Clinical Decision support that is configurable and customizable 4 Single Enterprise Drug File – Built and Managed Centrally – Limited Local Site configurations 4 Perpetual Inventory Management Capability 4 Ability to Support Electronic Prescribing 4 Ability to support external order checks – Drug-Drug, Duplicate therapy, etc. to include points of service outside of Enterprise (e. g. Retail Pharmacies) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 43

i. EHR Pharmacy Requirements Overview (cont. ) 4 Support workflow variations based on benefit – VA co-pays (adjudication) – Do. D no co-pays – Ability to Support both Do. D & VA mail orders 4 Support multiple workflows/volume – High volume workflow (some individual facilities processing over 4, 000 prescriptions daily) – Medical Centers, Clinics, etc. – Bank Teller and Batch processing This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 44

i. EHR Pharmacy Business Processes 4 Purpose and Scope – Align joint business processes and requirements for: • Inpatient Pharmacy (order fulfillment) • Outpatient Pharmacy (order fulfillment) • Inventory Management – Includes management of the Enterprise Product List (EPL) 4 Do. D/VA Pharmacy SMEs developed and documented high and midlevel joint pharmacy processes – Parent and Child models (3 levels) – 39 Models documented 4 The process models also are aligned to information models This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 45

i. EHR Pharmacy Business Processes Separate Processes (As-Is) Different mail order benefits: VA Consolidated Mail Outpatient Pharmacy (CMOP) & Tricare Home Delivery Joint Processes (To-Be) Benefits ü Supports an external fulfillment pharmacy process (e. g. CMOP, alternate dispensing location) and an external pharmacy transfer process (e. g. , retail pharmacy). ü Improved access to care (prescriptions are available at all points of service) ü Improved Beneficiary satisfaction (e. g. convenience ) ü Improved Operational Efficiencies (e. g. offload workload) ü Improved Provider/Pharmacy satisfaction (e. g. enterprise pharmacy system) Different third party collection processes § Do. D – post dispense process ü Supports a common 3 rdparty adjudication process § VA- real-time process This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. ü Complies with industry standards for just in time billing ü Improved accountability (e. g. accurate NDC) Delivery of Seamless Health Care and Benefits 46

i. EHR Pharmacy Business Processes Separate Processes (As-Is) External drug-drug interaction/ duplicate therapy order checks § Do. D utilizes the Pharmacy Data Transaction Service (PDTS) § VA –self reported non-VA supplied medications Locally maintained drug files within each Department Joint Processes (To-Be) Benefits ü Supports common ü Patient Safety (reduce adverse external drug-drug events) interaction/ duplicate ü Supports Prescription Drug therapy order check Monitoring Programs process against the patient's global medication profile through an external service ü Supports a centrally managed enterprise drug file that supports multiple formularies ü Standardized medication terminology across the enterprise ü Improved Operational Efficiencies (e. g. no longer locally maintained) ü Facilitates clinical decision support This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 47

i. EHR Pharmacy Business Process- Outpatient High-Level Joint “To-Be” Process (Level 1) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 48

i. EHR Pharmacy Business Process- Outpatient Sub-Process “To-Be” Outpatient Receive Prescription (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 49

i. EHR Pharmacy Business Process- Outpatient Sub-Process “To-Be” Outpatient Validate Prescription (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 50

i. EHR Pharmacy Business Process- Outpatient Sub-Process “To-Be” Outpatient Fill Prescription (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 51

i. EHR Pharmacy Business Process- Outpatient Sub-Process “To-Be” Outpatient Dispense Prescription (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 52

i. EHR Pharmacy Business Process- Outpatient Sub-Process “To-Be” Outpatient Administer Prescription (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 53

i. EHR Pharmacy Business Process- Inpatient High-Level Joint “To-Be” Process (Level 1) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 54

i. EHR Pharmacy Business Process- Inpatient Sub-Process “To-Be” Inpatient Receive Medication Order (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 55

i. EHR Pharmacy Business Process- Inpatient Sub-Process “To-Be” Inpatient Validate Medication Order (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 56

i. EHR Pharmacy Business Process- Inpatient Sub-Process “To-Be” Inpatient Fill Medication Order (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 57

i. EHR Pharmacy Business Process- Inpatient Sub-Process “To-Be” Inpatient Dispense Medication Order (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 58

i. EHR Pharmacy Business Process- Inpatient Sub-Process “To-Be” Inpatient Administer Medication (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 59

i. EHR Pharmacy Business Process- Inventory High-Level Joint “To-Be” Process (Level 1) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 60

i. EHR Pharmacy Business Process- EPL Enterprise Product List High-Level Joint “To-Be” Process (Level 1) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 61

i. EHR Pharmacy Business Process- EPL Sub-Process “To-Be” Perform Update Facility Product List (Level 2) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 62

Do. D/VA IPO i. EHR Technical Specification Package CAPT Hung Trinh

Agenda 4 Technical Specifications Package Overview 4 Service Oriented Architecture (SOA) Enterprise Service Bus (ESB) 4 Role of the Contractor with the IPO Integrator This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 64 Delivery of Seamless Health Care and Benefits

TECHNICAL SPECIFICATIONS PACKAGE OVERVIEW This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 65

Key Documents Technical Specification Summary Technical Specifications Request for Information (RFI) • Used for: • RFIs/RFPs/etc. Includes: • Memorandum of • Technical Specifications Understanding Summary (MOU) • Technical Architecture & • Memorandum of Artifacts Agreement (MOA) • Augmented by requirements decomposition • References full Technical Specifications This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. • RFI to industry July 17, 2012 Delivery of Seamless Health Care and Benefits 66

Definition of Terms Balance Scorecard Tech Spec Assessments 4 Technical Specifications Summary – Word document: Serves as one piece (Overview) of the larger Technical Specifications 4 Technical Specifications (TS) – Entire Set of Specifications: Includes the Technical Specifications Summary and all supporting architecture views and relevant artifacts that have been posted on http: //www. tricare. mil/tma/ipo/vendor. aspx (public knowledge) – Files are referenced in the Technical Specifications Summary and provide additional information and clarification for most sections contained in the Word document 4 Technical Specifications Request for Information (RFI) – RFI: Request for Information from industry vendors pertaining to the Technical Specifications Summary, its associated Technical Specifications (artifacts) and the specific questions/compliance criteria that are included within the RFI’s appendices This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 67 Delivery of Seamless Health Care and Benefits

Technical Specifications Overview Balance Scorecard Tech Spec Assessments 4 Role of the Technical Specifications Summary – Living document that is meant to offer potential support providers / future vendors with the technical specifications and requirements, as well as architecture products that define the needs for a standardized, interoperable, future state i. EHR environment – Each of the areas identified within the document will be included as part of RFIs / RFPs released from the IPO where vendors would require detailed understanding of specifications for the i. EHR technical environment (as-is and to-be). 4 Relationship to Architectures – Points to existing and planned architecture artifacts that will provide vendors with a vision of the future state i. EHR – Includes future Do. D, VA, and integrated Do. D/VA EHR programs, projects, and initiatives This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 68 Delivery of Seamless Health Care and Benefits

Technical Specifications RFI 4 Role of the Technical Specifications RFI Balance Scorecard Tech Spec Assessments – Targets the broader health IT industry market in order to gain insight into the adequacy, availability and experience of potential vendors and their products with respect to supporting an enterprise level i. EHR environment. 4 Release Date: July 17, 2012 via Federal Business Opportunities (Fed. Biz. Opps) – IEHR-IPO Technical Specifications RFI 4 Responses (Suspense – August 24, 2012) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. 69 Delivery of Seamless Health Care and Benefits

SOA ESB OVERVIEW This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 70

Overview 4 Service Oriented Architecture (SOA) Suite Informational Brief – Objective and Scope – Approach This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 71

OBJECTIVE AND SCOPE This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 72

Objective 4 Share information about the SOA Project This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 73

i. EHR “To Be” Architecture: Enterprise Service Bus • Facilitates development of business processbased common services • Promotes system interoperability • Provides enterprise application integration • Improves application integration • Enhances speed to market This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 74

i. EHR Overarching Architecture Common Do. D-VA Requirements: HL 7 EHR-S Functional Model with Do. D and VA vetted Extensions (SV-4) Common Do. D-VA Integrated Health Business Reference Model (OV-5) Common Do. D-VA “To Be” Process Flow Model (OV-6 C) Presentation (Common GUI) Do. D Unique Battlefie ld Care Military Readine ss Enroute Care Applications and Services Common (Joint) Applications & VA Unique Pediatri cs Pharma cy Personal Services Laboratory Health Record Blood Mgmt Nursing Home Long Term Care Obstetrics Disability Evaluation Inpatient Emergency Orders Mgmt Dept Care Document Mgmt Rehabilitative Care Transient Outreach Veterina ry Dental Care Consult & Operating Immunization Referral Mgmt Room Mgmt Occupational Health (VA) Common Interface Standards Common Services Broker (includes Enterprise Service Bus (ESB) and Infrastructure Services) Common Interface Standards Common Data Centers Common Information Interoperability Framework (CIIF) Common Information Model, Common Terminology Model, Information Exchange Specifications, Translation Service Common Data Standards: SNOMED CT and Extensions, LOINC and Rx. Norm Common Do. D-VA Measures of Effectiveness, Measures of Performance and Key Performance Parameters Joint Do. D/VA This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Do. D Only VA Only Delivery of Seamless Health Care and Benefits 75

i. EHR Technical Architecture Concepts (Notional) This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 76

SOA Scope The SOA Suite will provide a set of infrastructure components enabling the development, deployment and management of SOA services in support of a logical SOA infrastructure. Do. D/VA have identified 376 requirements, highly desirable or desirable features that the SOA Suite must meet. In addition, there are 15 capabilities that the SOA Suite must provide: 4 Initial capabilities rolled out as SOA Suite is implemented: 4 Additional capabilities implemented to enterprise as SOA matures: – Messaging – Orchestration – Performance Monitoring – Mediation – Service Registry/Discovery – Process Monitoring – Data/Messaging Transformation – Choreography – Security – Protocol Conversions – Rules Engine – Business Process Management – Quality of Service – Business Activity Monitoring – SOA Governance This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 77

APPROACH This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 78

i. EHR Regional and Local View at IOC This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 79

Current Conceptual Architecture – Local to Regional Communications Local Site Region Vist. A HL 7 MQ/SSL Layer 7 SSG HTTPS Policies Local Service IE Policies Local Service MQ/ SSL Layer 7 SSG MQ/SSL Service Web. Sphere SOA Suite Stack HTTP Layer 7 • Having local Layer 7 gateways allows for policy enforcement of local servers without having to route to the region. • Layer 7 Secure. Span SOA Gateway (SSG) provides encryption for Web services • Regional Layer 7 SSG provides authorization and access control for regional services • Local Layer 7 SSG provides authorization and access control for local services This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. HTTP Interface Engine (IE) • Having it locally enables message queuing (caching) at facilities in low/no-communication scenarios. • Local traffic can stay local instead of traversing the network to be routed by the regional SOA Suite. This reduces WAN traffic. • Transformations and other tasks can be performed locally to offload work from the regions. • It can filter invalid (e. g. error checking etc. . ) messages before they reach the region. Delivery of Seamless Health Care and Benefits 80

This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 81

Application Virtualization Hosting Environment (AVHE) Solution Overview This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 82

ROLE OF THE CONTRACTOR WITH THE IPO INTEGRATOR This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 83

Contractor and IPO Integrator Responsibilities The IPO intends to engage a single, separate Integrator to integrate the multiple COTS products for i. EHR. The IPO Integration contract shall capture the tasks necessary to fully integrate separate development components with the full range of the i. EHR Systems, and the new joint Do. D/VA Enterprise Architecture. 4 Responsibilities of i. EHR Pharmacy Contractor: – Responsible for discrete software components that can be seamlessly integrated into the system baseline – Provide specific, required functionality in a defect-free component that satisfies software assurance and information assurance criteria – Responsible for providing detailed technical support for the development of components required for integration of i. EHR systems – Responsible for defining and developing a strategy to migrate data from legacy systems into the COTS operational data store – Responsible for identifying and migrating all data that will be required to enable an end state where the COTS is fully functional while aligned with the target i. EHR architecture This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 84

Contractor and IPO Integrator Responsibilities 4 Responsibilities of IPO Integrator: – Responsible for validating the component compatibility with the i. EHR baseline – Responsible for supporting the DTC set up and testing – Responsible for maintaining the integration environments – Responsible for combining components into release packages without compromising the technical, software assurance and information assurance characteristics of the delivered component, so that new or updated software may be integrated into the existing system – Responsible for performing the connection of the component applications to the Enterprise Service Bus (ESB), and ensuring the applications and services are properly integrated with the ESB This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 85

Testing Expectations 4 Development Integration Test (DIT) to address the test objectives, test approach, test environment, success criteria, participant roles and responsibilities, documentation requirements, and schedule 4 Test Readiness Review (TRR) to present findings and to turn the developed function over to Configuration Management (CM) for subsequent Government testing 4 Smoke Test to allow the Government to conduct “smoke” testing of the application and utilize the results in a preliminary user satisfaction survey 4 Government software testing may include System Integration Testing (SIT), System Qualification Testing (SQT), System Acceptance Testing (SAT), Alpha/Beta Testing, and operational Test and Evaluation (OT&E) 4 Production Review (PR) to present the final results to the Government 4 The Contractor will also provide the following information: a) The number of tests performed shall be reported monthly with MPR b) The location of the tests c) Staffing composition for the tests d) Development/requirements effort for the tests e) The number of defects found and corrected during each test cycle f) Hardware configuration and procurement This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 86

Pre-Deployment Environments 4 Training and Demonstration – The ‘Sandbox’ – Provides the Users with a realistic training ground to learn basic application/system functionality – Test data in this environment is either masked production data stripped of key PII or generated/dummy test data with data triggers for each application under test – The vendor will also be responsible for following standard CMMI processes for versioning and storage of working or developed code 4 Development – Stage 1 – Provides the initial development ground for base code 4 Development Integration Test (DIT) – Stage 2 – The developed client requirements or code that has been validated by the Lead Developer will be promoted to the DIT environment – Replicates the production environment 4 Test – Stage 3 – Supports functional and technical requirement validation of the developed code in a separate environment – May contain other applications and will be identical to the production environment 4 Software Integration Test (SIT) – Stage 4 – Environment for testers to validate new software functionality, code repairs and/or enhancements – Replicates the production environment – The SIT environment is typically the last validation ground prior to releasing the developed software into production. This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 87

INTERAGENCY PROGRAM OFFICE i. EHR Pharmacy Request for Information – PWS Updates Patrick Shannon and Keith Tietmeyer

PWS 4 i. EHR Pharmacy released a Request for Information to Industry on 31 May 2012 4 Updated PWS released on 9 August 2012 4 Significant Updates – Scope Revision – Revision of Work Streams 1 and 2 to include Addition of Optional Tasks for creation of Computerized Provider Order Entry (CPOE) Graphic User Interface (GUI) – Addition of Business Process and Information Models This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 89

Revised Scope Revised Section 3. 0 Scope (emphasis added): “The Contractor shall provide a Commercial-Off-the-Shelf (COTS) solution to support i. EHR Pharmacy, to include Clinical Decision Support (CDS), licensing, training, support and maintenance, testing and installation, and with an option to include Computerized Provider Order Entry (CPOE) and support as described herein. The Contractor will be responsible for supporting the IPO Integration team in the performance of said activities. The Contractor will be responsible for providing development and implementation support activities required for integrating the COTS into the i. EHR Architecture. The actual integration and implementation will be performed by the IPO Integration and implementation teams. ” This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 90

Work Streams This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 91

Work Stream 1 Revised Work Stream 1: First Implementation Site “The tasks for Work Stream 1 are all concerned with the support for the first Implementation site, which is currently North Chicago. The current plans are to install the purchased COTS product at the Development and Test Center (DTC), integrating into the i. EHR ESB, then successfully implementing the capability at North Chicago (JALFHCC). ” This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 92

New Optional Tasks 4*New* Work Stream 1 Optional Tasks for First Implementation Site: – Task 7: Initialization of CPOE Graphical User Interface (GUI) – Task 8: Implementation of CPOE GUI – Task 9: Field Testing of CPOE GUI 4*New* Work Stream 2 Optional Tasks for Post. Implementation Sites: – Task 7: Initialization of CPOE Graphical User Interface (GUI) – Task 8: Implementation of CPOE GUI – Task 9: Field Testing of CPOE GUI This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 93

INTERAGENCY PROGRAM OFFICE Closing Remarks Anne Marie Vasconcelos, Acting Division Chief

Questions For vendors who have questions, Please complete the available index card with your Question. Answers will be provided by post to the Governmentwide Point of Entry, Fed. Biz. Opps: www. fbo. gov This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 95

Next Steps 4 Next Steps – Anticipated release of i. EHR Pharmacy RFP: 31 October 2012 – Anticipated Contract Award: by end of 1 st Quarter CY 2013 This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 96

One-on-One Sessions For those vendors who have requested One-on. One Session, sessions will be held at: VA TECHNICAL ACQUISITION CENTER (TAC) 260 INDUSTRIAL WAY WEST EATONTOWN, NJ 07724 This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 97

THANK YOU FOR YOUR ATTENDANCE! This document contains Booz Allen Hamilton Inc. proprietary and confidential information and is intended solely for internal use. Delivery of Seamless Health Care and Benefits 98