Monday, June 26, 2017

Isakson, McCain, Moran Urge VA, DOD to Partner on Implementation of Electronic Health Record System Integration


Senator Johnny Isakson is the Chair of the Senate Veterans Affairs Committee.  His office issued the following today:

Monday, June 26, 2017

Contact: Amanda Maddox, 202-224-7777

Kristen Hines, 202-224-9126

Isakson, McCain, Moran Urge VA, DOD to Partner on Implementation of Electronic Health Record System Integration

WASHINGTON – U.S. Senators Johnny Isakson, R-Ga., chairman of the Senate Committee on Veterans’ Affairs, John McCain, R-Ariz., chairman of the Senate Armed Services Committee, and Jerry Moran, R-Kan., chairman of the Senate Appropriations Subcommittee on Veterans Affairs, sent a letter to Department of Veterans Affairs (VA) Secretary David Shulkin and Department of Defense (DOD) Secretary James Mattis praising the VA’s recent announcement that it will transition to the same electronic health record system as the defense department.

In their letter, the trio highlighted the “importance of effective, efficient, and integrated health systems” and encouraged the two departments to work together as the VA makes the transition to ensure our service members receive seamless and high-quality health care.

“To remedy historical failures in sharing medical records information, Secretary Shulkin announced that the Department of Veteran Affairs would procure the same electronic health record platform as the Department of Defense to maximize continuity of medical care for service members transitioning to veteran status,” the senators wrote. “We commend you both for your bold leadership in this area, and are looking forward to more initiatives between the DOD and the VA to share assets and coordinate efforts related to caring for our service members and veterans.”

“We remain optimistic about the VA’s electronic health record transition; however … we implore the VA to work with DOD’s experts to adopt any lessons learned and best practices from DOD’s recent experience with electronic health record implementation,”the senators continued.

As chairmen of two committees and a subcommittee tasked with overseeing the VA and the Pentagon, the senators also requested a detailed response from Secretary Shulkin and Secretary Mattis regarding the expected timeline for implementation as well what steps are being taken to prevent unnecessary hiccups during the transition.

The full text of the letter is below and available online here.


June 26, 2017

The Honorable David J. Shulkin
Secretary of Veterans Affairs
U.S. Department of Veterans Affairs
810 Vermont Avenue NW
Washington, DC 20420

The Honorable James N. Mattis
Secretary of Defense
U.S. Department of Defense
1000 Defense Pentagon
Washington, DC 20301

Dear Secretary Shulkin and Secretary Mattis, 

As Secretary Shulkin recently stated, “VA and DoD have worked together for many years to advance [Electronic Health Records] EHR interoperability between their many separate applications at the cost of several hundred millions of dollars. …The bottom line is we still don’t have the ability to trade information seamlessly.” To remedy historical failures in sharing medical records information, Secretary Shulkin announced that the Department of Veteran Affairs (VA) would procure the same electronic health record (EHR) platform as the Department of Defense (DOD) to maximize continuity of medical care for service members transitioning to veteran status. We commend you both for your bold leadership in this area, and are looking forward to more initiatives between the DOD and the VA to share assets and coordinate efforts related to caring for our service members and veterans. The importance of effective, efficient, and integrated health systems cannot be overstated.

Recently, major federal IT infrastructure upgrades and overhauls have not had overwhelming success. We remain optimistic about the VA’s EHR transition; however, we hold great concern that the scope of this project brings several risks related to excess costs and implementation delays. We implore the VA to work with DOD’s experts to adopt any lessons learned and best practices from DOD’s recent experience with Military Health System (MHS) Genesis implementation. We cannot afford any mistakes on this project, as it has immense implications for the future of the VA and the proper care of our millions of veterans. While you work together to create and integrated EHR platform, we request that you address the following questions in your response to us:

·         Understanding the enormous scope of this project, what is the implementation and phasing plan?  What is the projected timeline and what are major completion milestones?
·         Given the Federal government’s history of IT upgrade challenges, what are DOD’s best practices and lessons learned that can be adopted by the VA? What specific plans, controls or managerial tools are the VHA prepared to execute to ensure the aforementioned best practices are reviewed and adopted, when prudent?
·         How can both Departments ensure the implemented solution will transcend DOD, VHA and community systems, following a veteran across the entirety of the provided care options, ensuring seamless, real-time access to medical records documentation?
·         What, if any, legislative hurdles or policy barriers do you foresee, and how can we work together to ensure the success of this joint initiative? 
·         What assessments of business process re-engineering will the VA undertake early in acquisition lifecycle of your EHR initiative?
·         What oversight mechanisms will you put in place to ensure that the VA has a sufficient understanding of the existing business processes to be changed and that the VA will avoid excessive customization of the selected commercial off-the-shelf system?
·         What efforts, if any, will be made to integrate Investment Review Boards (IRBs) at the beginning of the budget process to ensure sound budget decision-making in connection with this initiative?
·         Do the DOD and VA intend to align the tenure of program executives responsible for the execution of this initiative with key decision points, to improve their ability to hold responsible personnel accountable?

Capitalizing on joint ventures between DOD and VA reduces redundancies, realizes economies of scale, and combines shared resources for more comprehensive solutions. We encourage both of you to explore additional areas within your departments for opportunities to collaborate. The unification of EHRs serves as the linchpin for further joint solutions. The American people deserve excellence from each of your departments, and we know each of you have the expertise and institutional knowledge to succeed through collaboration. Patriotic Americans volunteer to defend our nation and defend democracy around the world. Although the DOD and VA are different agencies, it is your joint obligation to support our patriots and their families in their journey, from first oath to eventual resting place. We owe our best to our brave warriors.


Johnny Isakson   
John McCain                                                               
Jerry Moran


The Senate Committee on Veterans’ Affairs is chaired by U.S. Senator Johnny Isakson, R-Ga., in the 115th Congress. Isakson is a veteran himself – having served in the Georgia Air National Guard from 1966-1972 – and has been a member of the Senate Committee on Veterans’ Affairs since he joined the Senate in 2005. Isakson’s home state of Georgia is home to more than a dozen military installations representing each branch of the military as well as more than 750,000 veterans.

Iraq snapshot

Monday, June 26, 2017.  Chaos and violence continue, The Mosul Slog continues, Brett McGurk says a lot but none of it about diplomacy, and much more.

ALJAZEERA reports:

Islamic State of Iraq and the Levant (ISIL) fighters launched a string of counterattacks in a western Mosul neighbourhood, setting off clashes that continued overnight, Iraqi officials said on Monday.
An unknown number of suicide bombers and gunmen targeted the Hay al-Tanak and Yarmuk neighbourhoods, and set fire to houses and cars in Tanak, military officials told news agencies.
The area had been declared free of ISIL in May.
Several people are reported to have died in the attacks, which sowed panic among residents who had returned to the area, and prompted hundreds of families to flee overnight.

Yes, The Mosul Slog continues.

Day 246 of The Mosul Slog.

And, yet again, press reports circulate that it will be over shortly.

ASHARQ AL-AWSAT reports this morning, "The battle to take full control of Mosul from ISIS will be over in a few days, a general said Monday as Iraqi forces searched neighborhoods of west Mosul they retook weeks ago after a surprise jihadist attack on their rear that left several dead."

Searched neighborhoods of west Mosul they retook weeks ago . . .

How it repeats.

Over and over.

Here's the White House's special envoy Brett McGurk, speaking last week, trying to explain ISIS:

So what is ISIS? It is the largest, most sophisticated, and most global terrorist organization the world has ever seen.
Only two years ago, it controlled what was effectively a quasi-state, its so-called caliphate, with territory the size of Lebanon spanning across Iraq and Syria.
It controlled millions of people, entire cities, dual capitals in Raqqa and Mosul, generating revenue through oil and gas, taxes, antiquities trade, hostage taking, of more than a billion dollars per year.
It enslaved thousands of young girls, committed acts of genocide against minority groups, Yazidis and Christians, and sought to destroy our common human heritage, from Palmyra in Syria, to the Ninewa plains in northern Iraq.
It also established franchises, seven in all, from Sinai just to our west, to Afghanistan, Libya, and Nigeria, all with central direction and planning from ISIS’s capital in Raqqa.
And it sought to spread terrorism to all of our homelands, directing attacks from Raqqa … in Paris, Istanbul, and Brussels, and inspiring them from London, to Berlin, to Garland, Texas.
Its manpower at its height in 2015, while hard to pinpoint specifically, was in the upper tens of thousands – hard core fighters, at least.
The figures we can pinpoint are staggering: more than 40,000 foreign fighters, Jihadists, flooded into Syria between 2013 and 2016 from over 100 countries all around the world. The world had never really seen anything like it – the supercharged global Jihad.
General Gilead, many of us in this room, were extremely alarmed by this phenomenon as early as 2013. Many of us in Washington, some of my former colleagues here, were also discussing it with extreme concern.
Foremost attention among many, however, in those years, I think we have to be honest, there was a belief, by some, that this flood of Jihadist fighters could somehow be tamed and contained – after Bashar al-Assad was removed from power. I think that was a false assumption and it carried some tragic consequences.
The flood of extremist fighters and weapons into Syria combined with the crimes of the Asad regime created an explosive environment for al Qaeda, from which ISIS sprung.
ISIS rapidly spread, in 2013, across eastern Syria, killing anyone who sought to confront it. It spread openly into Iraq in early 2014, capturing Fallujah, and laying siege to Ramadi in Anbar province.
Suicide attacks in Iraq nearly all of whom at the time were committed by foreign fighters, people coming from around the world into Syria and Iraq to blow themselves up – rose from five to ten per month in 2012 to sometimes 60 per month in 2014, targeting markets, mosques, soccer games, local officials – mayors, town councils – and security personnel.
In June, 2014, Mosul, a city of nearly 2 million people, fell to ISIS; and its leader Abu Bakr Baghdadi, declared a caliphate from the grand Mosque of Al Nuri in Mosul’s old city. And late yesterday, as Iraqi Security forces closed in on that mosque, about 100 meters away, ISIS blew it up. A mosque which sat there since the 12th century, ISIS blew it up. The last month in Mosul is really telling. Summer of 2014, Baghdadi announces from that mosque that he’s the caliph creating a caliphate—the caliph proclaims his legitimacy by this ability to protect people in his so called caliphate. All of this was a false lie. But that’s what he said in the summer of 2014.
In the last month, as Iraqi Security forces closed in on that last district in Mosul, ISIS has killed any civilian trying to leave. They used a hospital on some high ground, just north of the old city, as a killing tower—with snipers killing any civilians trying to leave. We’ve actually been accused, our forces, of using white phosphorus for example, in Mosul. And I defer to our military professionals, but they use white phosphorus not to target anybody, not to kill anybody, but as a shield to allow civilians to escape. We were somehow declared of using this ammunition which was harming civilians. In fact, we were helping civilians escape as ISIS sat in a tower—a hospital which we did not want to target—and killed anyone that tried to leave. And last night they blew up the mosque in which Baghdadi declared his caliphate, I think it was a very significant moment here in the last 24 hours.
But back in 2014, if you rewind the tape, this announcement of a caliphate accelerated recruitment from around the world, with thousands of men, women, and even children, traveling through Turkey and into Syria through established smuggling networks.
About a month later in July 2014, ISIS broke through the western Iraqi border at al Qaim and approached Baghdad down the Euphrates valley, and also in the north along the Tigris valley.
Near Tikrit that summer in 2014, ISIS terrorists rounded up One Thousand Seven Hundred young Iraqi military cadets, and murdered them one-by-one, and they filmed the scene on YouTube.
I was in Iraq at the time. Newspaper headlines declared Baghdad was about to fall. There were reports of an ISIS “zero hour” in the capital and it was causing a panic among the population. We in fact reduced our embassy personnel and dusted off contingency evacuation plans given the uncertainty.
President Obama early in this crisis asked for my recommendation among others, some that are in this room, Elissa Slotkin among others, about what we should do. And our only response was we had to fight back – and fight back soon because there we had no other choice.
But we had to fight smartly, not with U.S. forces in Iraqi and Syrian towns and villages; but by strengthening local forces – Syrians and Iraqis – to take on the fight themselves, combined with devastating air power, and importantly with a political strategy that empowered people at the local level to secure their own communities, with a government in Baghdad that was responsive to its people.
We had to rally the world – particularly the Muslim world – to take on the fight themselves, combating ISIS’s poison in the mosques and online and in the media 24/7.
We had to ensure that what came after ISIS was more stable, creating the conditions for people to return to their homes and rebuild their devastated communities.
And we had to prepare a campaign that targeted ISIS financing, foreign fighter networks, global affiliates, and propaganda.
In the summer of 2014, that seemed a nearly impossible task –the Iraqi Security Forces had just completely and totally collapsed and we had almost nobody to work with on the ground in Syria--but we got to work.
We built a global coalition against ISIS, that is now the largest of its kind in history with 71 members, including 67 nations, plus NATO, INTERPOL, the EU, and the Arab League.
Early on, we organized this grand coalition around five specific lines of effort, each focusing on a particular aspect of the ISIS problem and pooling global resources to confront it:
First, we provide military support to our partners on the ground;
Second, we work to stop the flow of foreign fighters, by securing the border between Syria and Turkey and severing the international networks.
Third, halting ISIS access to financial support;
Fourth, we address the humanitarian and stabilization in areas cleared of ISIS to allow the population to return;
Fifth, we combat ISIS’s poisonous ideology.
The first airstrikes by our coalition were launched in September, 2014. There have been nearly 30,000 since, it’s been the most precise air campaign in history, and combined with aggressive and innovative global initiatives along each of the lines I just mentioned.

And while this war is far from over, the results to date are promising. 

Are the results promising?

Many observers note the destruction of Mosul.

That's promising?

Brett outlines a now three year program above.

But where's the diplomacy?

Where's the work beyond military?

Nothing has been done.

At some point, you have to argue that this was intentional.

The Islamic State rose in Iraq because then-prime minister Nouri al-Maliki was persecuting the Sunnis.

Has that persecution ended?


Even now there are reports -- and photographs -- of Sunni civilians being tortured and killed.

When does that get addressed?

Smart people argued the time to address it was years ago.

But, under Barack Obama, the White House rewarded Nouri.

Even when the voters gave him the heave-ho in 2010, Barack still supported Nouri for a second term and had US officials ont he ground in Iraq negotiate The Erbil Agreement to give Nouri a second term.

ISIS didn't rise in a vacuum.

The conditions that allowed it to take root still exist.

So now what?

Sarhang Hamasaeed and Michael Yaffe (WASHINGTON EXAMINER) offer:

That will require sustained attention to the "Three Rs:" Relief, Reconstruction and Reconciliation, all of which are needed concurrently. Relief means not only continued humanitarian aid but also security assistance to protect reconstruction and reconciliation and to facilitate the return of 3 million displaced people.
Political and social reconciliation, in turn, will be needed to prevent violence and reprisals and make way for sustainable reconstruction. The U.S. should develop a plan to help resolve fundamental national and regional political issues that will allow Iraq's constellation of groups to co-exist in peace.

Already, unity is fraying among forces that stood against ISIS. Sinjar, Tel Afar and Tuz Khurmatu have emerged as flashpoints of incipient conflict. Wrangling between the Kurds and Baghdad over oil, territory and Kurdish independence continues as regional powers such as Iran, Saudi Arabia and Turkey— as well as Iraqi groups — jockey for influence. Since the ISIS onslaught in 2014, for example, Popular Mobilization Forces militias, most supported by Iran, have established offices all over Iraq — 16 just in one town south of Mosul, Iraqis tell us — in a bid to gain control in areas recaptured from ISIS. As next year's parliamentary elections approach, they'll be well positioned to buy cooperation, exert authority and support to candidates, further solidifying their grip.

Maybe the time to start this sort of work was in 2014 and not in a mad rush to beat the next election?

New content:

Sunday, June 25, 2017

DoD vs. CIA in Iraq?

A number of e-mails have come in about this topic:

Tillerson plans to remove Iraq, Myanmar from a U.S. list of the world's worst offenders in the use of child soldiers

I don't see the point.

In any of it, I don't see the point.

Child soldiers have been used in Iraq over the last 8 years.

We've noted it repeatedly.

It's not mattered.

So does it real many anything at this point whether or not Iraq is on some list?

I'd be thrilled if we could all share outrage over the use of child soldiers.

But that's not what's happened.

Whether it's on a list or not, is not among the big issues effecting Iraq.

It's like the Leahy Amendment -- it's not being enforced.

What was the point of it if no one was ever going to enforce it?

Yes, we get some grousing every now and then and that's about it.

Meanwhile, it's day  245 of The Mosul Slog.

This is not a video game. Federal Police Units engaged in urban warfare with militants in Old city.

And the slog continues.

A USAF Airman scans for Isis fighting positions near Al Tarab, Iraq during the offensive to liberate West Mosul, Operation Inherent Resolve.

Meanwhile, here's a view of the Iraq War the corporate media doesn't give voice to.

US oil wars in Iraq and have descended to the absurd, where Islamic State, a DoD proxy army, fights Peshmerga, a CIA proxy army.

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