TTA’s Summer Kickoff Week Four: CVS-Aetna looks like a loser in court, Best Buy’s buy of CST may be a winner

 

 

Best Buy increases its telehealth footprint with CST buy. But CVS-Aetna is apparently going to be a long time in court.

Best Buy buys Critical Signal Technologies, increasing telehealth footprint (More chips on their big bet on health tech)
CVS-Aetna merger will run off the tracks in Federal court: reports (Not looking good for them or other companies involved, but there’s always appeals)

Digital health’s promise to democratize and commoditize health remains elusive. CVS-Aetna finally has its days–three–in court, and the implications.

Digital health: why is it a luxury good in a world crying for health as a commodity? (Three big reasons)
The CVS-Aetna hearing is on the move–finally (Day 1 of a 3-day hearing)

If you’ve missed behavioral and predictive telecare, IBM may be on The Road To Revival with its LiDAR pilot. And Call9 may be just the savings number for SNFs–and a life-saving one for patients.

IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care (LiDAR powered, just like AV cars)
Call9 and an ’embedded’ approach to emergency response in nursing homes (A cost and life-saving area, ignored till recently)

Leading up to the official start of summer (both US and UK), Teladoc gets ‘corrected’, Epic adds Tyto Care to patient portal, Bayer’s G4A and Yorkshire & Humber accelerate, GSK awards. Digital health goes to summer school in Florence 24-27 June, but you’ll be back for DHACA Day in London 9 July.

Global news roundup: Italy’s digital health summer school, GSK Impact Awards, Propel@YH for Yorkshire & Humber digital health, Aging 2.0 engages seniors
Bayer 2019 G4A Partnerships now open for applications through 31 May (An accelerator with international impact–apply quickly!)
Tyto Care telehealth integrates with Epic EHR MyChart patient app (A digital exam integrates with the big, bad EHR)
Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated) (Not good short term, but this 9,000 lb elephant is not going anywhere)
Next DHACA Day 9th July, London – seeking new members (psst–it’s free) (Get help to develop your UK digital health products and services)

CVS and Aetna await their hearing on how their merger isn’t anti-competitive, but others ‘spring’ ahead with acquisitions, fresh funding, FDA clearances, and interesting events. And Jawbone makes the case for resurrection.

News, events roundup: FDA clears AliveCor’s first 6 lead ECG, Jawbone Health rises from ashes, Let’s Get Checked’s $30M check, Health Wildcatters’ $35M ‘how to’ breakfast
CVS-Aetna hearing starts June 4; now only 6 witnesses called, for and against (updated) (The drama continues for the 9th month)
Harris Healthcare acquires in-hospital workflow tech pioneer Uniphy Health (A NJ innovation success bringing better communications to hospitals)
Events, dear friends, events in London from painting to leadership (From Arts in Health to HealthChats and The King’s Fund in summer)

Psychiatry goes ‘hybrid’, health tech gets NICE, events both coming up and future, and in long-running shows, CVS-Aetna and Theranos keep packing them in.

Telepsychiatry improves time to care plus frequency of care for behavioral health patients: study (Now it’s hybrid psychiatry)
CVS-Aetna hearing now June; 12 witnesses called, for and against (Another long-running DC show in its ninth month)
It’s NICE to HealthTech Connect with the NHS (A health tech matchmaking service)
The Theranos Story, ch. 60: becoming a Cautionary Tale of Silicon Valley Ethics (Will SV change its ways? Not likely.)
Events coming up soon–and in the autumn: Hunter College 13 May, Aging 2.0 London 21 May; NYeC’s November Gala, Connected Health Summit (16-18 Oct) poster call


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We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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TTA’s Summer Kickoff Week Three: digital health’s failure to date to lower health costs, CVS-Aetna’s days in court start

 

 

Digital health‘s promise to democratize and commoditize health remains elusive. CVS-Aetna finally has its days–three–in court, and the implications.

Digital health: why is it a luxury good in a world crying for health as a commodity? (Three big reasons)
The CVS-Aetna hearing is on the move–finally (Day 1 of a 3-day hearing)

If you’ve missed behavioral and predictive telecare, IBM may be on The Road To Revival with its LiDAR pilot. And Call9 may be just the savings number for SNFs–and a life-saving one for patients.

IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care (LiDAR powered, just like AV cars)
Call9 and an ’embedded’ approach to emergency response in nursing homes (A cost and life-saving area, ignored till recently)

Leading up to the official start of summer (both US and UK), Teladoc gets ‘corrected’, Epic adds Tyto Care to patient portal, Bayer’s G4A and Yorkshire & Humber accelerate, GSK awards. Digital health goes to summer school in Florence 24-27 June, but you’ll be back for DHACA Day in London 9 July.

Global news roundup: Italy’s digital health summer school, GSK Impact Awards, Propel@YH for Yorkshire & Humber digital health, Aging 2.0 engages seniors
Bayer 2019 G4A Partnerships now open for applications through 31 May (An accelerator with international impact–apply quickly!)
Tyto Care telehealth integrates with Epic EHR MyChart patient app (A digital exam integrates with the big, bad EHR)
Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated) (Not good short term, but this 9,000 lb elephant is not going anywhere)
Next DHACA Day 9th July, London – seeking new members (psst–it’s free) (Get help to develop your UK digital health products and services)

CVS and Aetna await their hearing on how their merger isn’t anti-competitive, but others ‘spring’ ahead with acquisitions, fresh funding, FDA clearances, and interesting events. And Jawbone makes the case for resurrection.

News, events roundup: FDA clears AliveCor’s first 6 lead ECG, Jawbone Health rises from ashes, Let’s Get Checked’s $30M check, Health Wildcatters’ $35M ‘how to’ breakfast
CVS-Aetna hearing starts June 4; now only 6 witnesses called, for and against (updated) (The drama continues for the 9th month)
Harris Healthcare acquires in-hospital workflow tech pioneer Uniphy Health (A NJ innovation success bringing better communications to hospitals)
Events, dear friends, events in London from painting to leadership (From Arts in Health to HealthChats and The King’s Fund in summer)

Psychiatry goes ‘hybrid’, health tech gets NICE, events both coming up and future, and in long-running shows, CVS-Aetna and Theranos keep packing them in.

Telepsychiatry improves time to care plus frequency of care for behavioral health patients: study (Now it’s hybrid psychiatry)
CVS-Aetna hearing now June; 12 witnesses called, for and against (Another long-running DC show in its ninth month)
It’s NICE to HealthTech Connect with the NHS (A health tech matchmaking service)
The Theranos Story, ch. 60: becoming a Cautionary Tale of Silicon Valley Ethics (Will SV change its ways? Not likely.)
Events coming up soon–and in the autumn: Hunter College 13 May, Aging 2.0 London 21 May; NYeC’s November Gala, Connected Health Summit (16-18 Oct) poster call

International digital health news from India, Finland, Hong Kong, and even the US leads our roundup, from Verily, Oxford VR, Blackberry, Blue Cedar, and more. 

International news roundup: Verily ‘eyes’ India, Oxford VR trials in Hong Kong, Israel-Finland collaborate, Blue Cedar-Blackberry partner, NuvoAir inhales $3M
 

It’s really Spring this week. Theranos lives again, courtesy of the Patent Office, while reliving its demise is postponed in court. Machine learning is starting to shine on radiology. New event at RSM and a major EU prize. But it feels like autumn for Athenahealth, Watson Health, and Waystar.

Comings and goings: Cuts hit Athenahealth, IBM Watson’s Drug Discovery unit; Bain may sell Waystar RCM (Mostly goings)
The Theranos Story, ch. 59: there’s life left in the corporate corpse–patents! And no trial date in sight. (A kind of resurrection, courtesy of the USPTO)
AI and machine learning ‘will transform clinical imaging practice over the next decade’ (Radiology catching up)
Digital Technologies for Disease Prevention and Promotion of Wellbeing – RSM, London, 10th June 2019 (A don’t miss event)
Win the Trillium II prize and get €1,000! (For publicizing and deploying the International Patient Summary)


Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: http://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Digital health: why is it a luxury good in a world crying for health as a commodity?

Why digital health still struggles to find its stride. Those of us in the healthcare field, especially Grizzled Pioneers, have been wondering for the past decade why Digital Health’s Year is always Next Year. Or Next Decade. 

Looking back only to 2000, we’ve had 9-11, a dot-com bust, a few years in between when the economy thrived and the seed money started to pollinate young companies, a prolonged recession that killed off many, and now finally a few good economic years where money has flooded into the sector, to good companies and those walking the fine line of mismanagement or fraud. We’ve seen the rise/fall/rise of sensors, wearables, and remote monitoring, giants like Google and Microsoft out and back in, the establishment of EHRs, acceptance by government and private payers, quite a bit of integration, and more. All one has to look is at the investment trends breaking all records, with funding rounds of over $10 million raising barely a notice–enough to raise fears of a bubble. Then there’s another rising tide–that of cyberattack, ransomware, insider and outsider hacking.

Is it this year? It may not be. Despite the sunshine, interoperability holds it all back. Those giant EHRs–Cerner, Epic, Athenahealth, Allscripts–are largely walled gardens and so customized by provider application that they barely are able to talk to their like systems. There are regional health exchanges such as New York’s SHIN-NY, Maryland’s CRISP, and others, but they are limited in scope to their states. The VA’s VistA, the granddaddy of the integrated system, died of old age in its garden. Paul Markovich, CEO of Blue Shield of California cites the lack of interoperability and being able to access their personal health data as a major barrier to both patients and to the large companies who want to advance AI and need the data for modeling. (China and its companies, as we’ve noted, neatly solve this problem by force. [TTA 17 Apr]) Apple is back in with Health Records, but Mr. Markovich estimates it may take 10 years to gather the volume of data it needs to establish AI modeling. Some wags demand that Apple buy Epic, as if Epic was up for sale. BSC, like others, is testing interoperability workarounds like Notable, Ooda Health, and Manifest MedEx. Mr. Markovich cites interoperability and scaling as reasons why healthcare is expensive. CNBC

And what about those thriving startups? Hold on. During the Google Cloud/Rock Health 3 June event, one of the panelists–from Partners HealthCare, which works both side of the street with Pivot Labs–noted that hospitals have figured out their own revenue models, and co-development with hospitals is key. Even if validated, not every tech is commercially ready or lowers cost. And employers are far worse than hospitals at buying in because they ultimately look at financial value, even if initially they adopt for other reasons. In addition, the bar moved higher. The new validation standard is now provider-centric–workload, provider satisfaction, and implementation metrics, because meeting clinical outcomes is a given. Mobihealthnews

And still another barrier–data breaches and cyberattack–is still with us, and growing. Quest Diagnostics’ data breach affects nearly 12 million patients. It was traced to an individual at a vendor, American Medical Collection Agency, and it involved Optum360, a Quest contractor and part of healthcare giant Optum. The unauthorized person had access to the network for eight months – between 1 August 2018, and 30 March 2019–and involved both financial and some health records. Quest now is in the #2 slot behind the massive 79 million person Anthem breach, which, based on a Federal grand jury indictment in Indianapolis in May, was executed by a Chinese group in 2015 using spearfishing and backdoors that gathered data and sent it to China. There were three other US businesses in the indictment which are not identified. Securing health data is expensive — and another limitation on the cost-lowering effects of interoperability. Healthcare IT News

Digital Health’s Year, for now, will remain Next Year–and digital health for now will remain fractional, unable to do much to commoditize healthcare or lower major costs.

News roundup: FCC RPM/telehealth push, NHS EHR coding breach, unstructured data in geriatric diagnosis, Cerner-Lumeris, NHS funds social care, hospital RFID uses

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”125″ /]FCC backs post-discharge RPM plan. The “Connected Care Pilot Program” proposed by FCC commissioner Brendan Carr would provide $100 million for subsidies to hospitals or wireless providers running post-discharge remote monitoring programs for low-income and rural Americans such as those run by the University of Mississippi Medical Center. The goal is to lower readmissions and improve patient outcomes. The proposal still needs to be formalized so it would be 2019 at earliest. POLITICO Morning eHealth, Clarion-Ledger, Mobihealthnews

NHS Digital’s 150,000 patient data breach originated in a coding error in the SystmOne EHR used by GPs. Through the error by TPP, SystmOne did not recognize the “type 2 opt-out” for use of individual data in clinical research and planning purposes. This affected records after 31 March 2015. This breach also affects vendors which received the data, albeit unknowingly, but the duration of the breach makes it hard to put the genie back in the bottle, which NHS Digital would like to do. Inforisktoday, NHS Digital release

Unstructured data in EHRs more valuable than structured data in older adult patient health. A new study in the Journal of the American Geriatrics Society compared the number of geriatric syndrome cases identified using structured claims and structured and unstructured EHR data, finding that the unstructured data was needed to properly identify geriatric syndrome. Over 18,000 patients’ unstructured EHR notes were analyzed using a natural language processing (NLP) algorithm.

Cerner buying a share in population health/value-based care management company Lumeris through purchasing $266 million in stock in Lumeris parent Essence Group Holdings. The angle is data crunching to improve outcomes for patients in Medicare Advantage and other value-based plans. Lumeris also operates Essence Healthcare, a Medicare Advantage plan with 65,000 beneficiaries in Missouri. Fierce Healthcare

NHS Digital awarding £240,000 for investigating social care transformation through technology. The Social Care Digital Innovation Programme in 12 councils will be managed by both NHS and the Local Government Association (LGA). Projects to be funded span from assistive technologies to predictive analytics. Six winners from the original group of 12 after three months will be awarded up to a further £80,000 each to design and implement their solutions. New Statesman

Curious about RFID in use in healthcare, other than in asset management, access, and log in? Contactless payments is one area. As this is the first of four articles, you’ll have to follow up in Healthcare IT News

VA moves closer to doing Cerner EHR deal, real Choice for veterans (updated)

The Cerner EHR deal with the VA edges closer to closing. Another VA contractor, MITRE, reviewed the agreement and recommended 50 changes that, according to POLITICO Morning eHealth’s source, address many of the interoperability-related usability features “that irritate EHR users” such as reconciling data coming from outside sources (Home Telehealth, perhaps?–Ed.). VA officially updated the status with Congressional Veterans Affairs staff on Tuesday. The deal could be inked as early as next week, but never bet on this when the Secretary seems doubtful of the agreement date. In any case, it will be a decade before VA is fully transitioned from VistA. Speaking of the Secretary, Dr. Shulkin’s crisis of last week seems to have passed with a White House vote of confidence. He can ‘cashier’ his critics and according to him, everyone’s on board with a clear direction. We’ll see. 

Updated. Well, it’s 2 March and still no word on closing the Cerner contract. Meanwhile, the VA ‘revolt’ continues, with either true or false reports of demands for Dr. Shulkin’s resignation. It’s exhausting, and meanwhile who pays? Staff and veterans. See POLITICO from 1 March here.

Modern Healthcare reported that important reforms in the VA Choice legislation are closer to reality with the Senate Veterans Affairs committee. They are proposing changes, supported by the White House, that would open up VA Choice eligibility to nearly all veterans by “making VA facilities responsible for meeting access standards set by the VA secretary. If a facility can’t, the patient can seek out a community provider if both patient and a VA provider or an authorized provider in the community working closely with VA deem that a better option than a VA facility.” This is a step beyond the earlier proposed access standards which would have given the VA Secretary discretion to relax restrictions to community care provision. Currently the VA Choice program is used by only 1 million veterans who have to prove that they are facing wait times of 30 days or more, or 40-mile travel time to a VA clinic. While the tone in the article is slightly disparaging, firm standards and opening the VA to limited market pressures to this Editor is a good thing–and getting effective care faster to veterans, many of whom live in exurban or rural areas, is beyond all considerations, absolutely necessary. How this affects veterans monitored by telehealth programs–and interoperability of their records–are open questions.

EHR action: Allscripts acquires Practice Fusion, expands footprint in small/ambulatory practices

A significant EHR acquisition kicks off an action-packed week. Announced today by leading EHR Allscripts is their acquisition for $100 million of independent practice EHR Practice Fusion. Allscripts, which has been usually in the top five US EHRs (Kalorama April 2017 survey), vastly expanded its hospital market share with August’s acquisition of #2 McKesson‘s health IT business and with this would be ranked just behind EHR leader Cerner. In acute care settings, Epic and Cerner dominate with 25 percent of the market each with Allscripts/McKesson far behind #3 Meditech (KLAS April 2017). 

Practice Fusion, one of the pioneers in the small practice/ambulatory EHR starting with a basic free, ad-paid model in 2005, has 30,000 ambulatory sites serving about 5 million patients each month. In the Allscripts view, they will now be able to offer “last mile” reach to the under-served clinicians in small and individual practices” and close gaps in care. Allscripts President Rick Poulton noted in the statement that “We believe this transaction will directly benefit Practice Fusion clients, who will now have access to Allscripts solutions and services. We look forward to welcoming Practice Fusion team members to our family.” which leads one to believe that the Practice Fusion name will be sunsetted. Allscripts release and Healthcare IT News

From being the leader in small practice EHRs, Practice Fusion found the last few years difficult as competition expanded into their segment, from eClinical Works, drchrono, athenahealth, and NextGen to small practice packages from Epic and Cerner.

It should be noted that Practice Fusion in 12 years went through 13 funding rounds, raising almost $158 million from a long list of VC luminaries such as Kleiner Perkins, Artis Ventures, Founders Fund, and Qualcomm Ventures (Crunchbase). However, it disappointed its investors and Wall Street, which expected two years ago a $1.5 billion IPO. The $100 million from Allscripts is all cash and the price is “subject to adjustment for working capital and net debt”–an exit which was surely not the sugarplum in the eyes of its 2014 and prior  investors. CNBC

A basket of reflections, considerations on CVS-Aetna: Epic, Cerner, the model, and hospitals’ role

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]With the holidays and the end of the year coming in a little over two short weeks, there’s plenty of room for thoughts, reasoned speculation, and some unusual takes on the CVS-Aetna merger. This Editor remains in her belief that among us, there’s a bit of exhaustion and an attitude of ‘wait and see’ around the topic among us. The canaries have a case of the vapors….

Let’s sort through some of the more interesting POVs expressed of late by our fellow pressies, which Readers can consider in between cups of good cheer and bites of All That Food. Bear in mind that this merger has a long road to go on a hard road, with potholes marked DOJ and (in this Editor’s opinion) HHS, before it’s a done deal in 2018.

  • A big win for Epic. Currently the EHR for CVS’ MinuteClinics and most recently the care management programs of CVS Specialty, Epic is bullish on the opportunities in what their VP of population health termed the ‘gray space’ in the patient experience outside of the traditional sites of care. In October, CVS added Epic’s Healthy Planet population health analytics platform to learn more about drug dispensing patterns and medication adherence–this Editor believes in preparation for merger talks. The open question this Editor has after all the glow in this article is how Aetna’s varied systems (e.g. ActiveHealth, Medicity, and others) would integrate into Epic, and the price of poker, because with Epic it’s never free. Ask any hospital. Healthcare IT News.
    • Certainly, their main competitor Cerner is feeling the heat after a slowdown in its VA plans, the single largest EHR implementation ever. Congress has held up initial funding making the contract effective (Washington Technology). It is geometrically more complicated than their simultaneous DoD implementation, with $10 billion estimated over 10 years (FCW). Other wrenches in the works: a fresh CliniComp lawsuit against Cerner based on infringement against their 2003 patent on remote hosting, and their appeal of the no-bid award to Cerner [TTA 23 Aug] against VA. Kansas City Business Journal, Healthcare IT News
  • Is it going to increase cost? It might. And what about info sharing with providers? A Harvard Medical School professor opined to Marketplace that instead of self-treatment at home for a cold, the patient might actually traipse to a MinuteClinic for care, thus driving up healthcare costs. This resembles the RAND logic around telemedicine consult expense we deflated in a series of articles back in the spring. Information sharing with regular providers is a bigger issue which urgent cares, telemedicine, and clinics already are dealing with. The paradox is that integration with a payer, with a retailer’s ability to track ancillary purchases such as OTC meds and DME purchases, might actually help that issue. But will it? Will a combined CVS-Aetna share information or hoard it, further disempowering patients? This Stat article calls on Mark Bertolini to promote shared information, engagement, and accountability to balance the scales.
  • Do we really need hospitals? If they don’t change, we might need a lot less of them except for highly specialized treatment. And this is likely a good thing. The HBR points out that CVS-Aetna is hardly the only threat to the traditional hospital–there’s Johns Hopkins’ Hospital at Home program for older adults, UnitedHealthcare’s growing network of providers under OptumCare, including the recent deal for DaVita dialysis centers, and free-standing, low-cost “neighborhood” hospitals, almost like pop-up stores. The article doesn’t mention ‘consult stations’ like Europe’s H4D, which is proving that the kiosk idea isn’t dead. 

The reality is that we won’t know what this merger entails until it actually happens, if it happens–and its final shape will take years to mold. Related: CVS-Aetna: the canary says that DOJ likely to review mergerAnalysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?CVS’ bid for Aetna–will it happen, and kick off a trend? (what will Amazon and other retailers, including supermarkets, do?)

VA EHR award to Cerner contested by CliniComp (updated)

See update below. CliniComp International, a current specialized EHR vendor to some Department of Veterans Affairs locations and to the Department of Defense for clinical documentation since 2009, has filed a bid protest in the US Court of Federal Claims on Friday 18 Aug, saying that VA improperly awarded a contract to Cerner in June [TTA 7 June] without a competitive bidding process.

At the time, VA Secretary David Shulkin moved the award via a “Determination and Findings” (D&F) which provides for a public health exception to the bidding process. Without this, competitive bidding could take six to eight months, as Dr. Shulkin stated to a Congressional committee after the award–or two years, as DoD’s did–and would have further slowed down the already slow adoption process. Even if all goes well, the transition from VistA to Cerner will not begin at earliest until mid-2019 [TTA 14 Aug]. The Cerner MHS Genesis choice was also logical, given the Federal demand for interoperability with DoD. In June, the House Appropriations Committee approved $65 million for the transition, provided that VA provides detailed reports to Congress on the transition process and its interoperability not only with DoD’s but also private healthcare systems.

CliniComp objected to all that, saying in the protest that VA had enough time for an open bidding procedure, that the failure to do so was “predicated on a lack of advance planning,” and that awarding it to Cerner without it was “unreasonable”. “As shown by the nine counts set forth below, the VA’s decision to award a sole-source contract to Cerner is arbitrary, capricious, an abuse of discretion and violates the CICA and Federal Acquisition Regulations,” according to the suit.

According to Healthcare IT News, “CliniComp said it filed an agency-level protest to contest the sole source award shortly after the announcement, according to the complaint. But the VA Deputy Assistant Secretary for Acquisition denied the protest on Aug. 7. In doing so, the VA violated the Competition in Contracting Act of 1978, the company claims.”

This is not CliniComp’s first bid protest. Before one dismisses the bid protest as sour grapes picked by a minor vendor, this Editor discovered via Law360 that CliniComp was successful in a VA bid protest in August 2014. In this case, VA had a $4.5 million contract for computer systems at several intensive care units for saving patient waveform biometrics. The VA’s award to Picis in October 2013 was overturned because the Court of Federal Claims found that in clarifying the CliniComp bid, VA never had official discussions with CliniComp, only informal requests for clarifications. The court found that the two bids were not evaluated the same way–and that likely both were acceptable, with CliniComp’s bid preferable because it was lower. (More on CliniComp and its 30-year history here)

Update. Arthur Allen in POLITICO Morning e-Health also did his homework and found the same Law360 article on CliniComp’s 2014 bid protest win, adding the following:

  • DoD and VA officials have complained that CliniComp’s software is not compatible with legacy systems. However, some IT experts have noted that neither DoD nor VA can provide platforms which can be interoperable with Cerner. (Circular firing squad?)
  • Oral arguments are set for 2 October, if necessary, after motions are filed next month. Cerner joined in the defense against the protest as of Monday. 

Will the brakes be put on Cerner’s work while the protest wends its weary way through the Federal Claims Court? The bid protest is high-profile embarrassing for VA, though the D&F is completely legal. Stay tuned. Also Modern Healthcare, KCUR, Healthcare Dive

VA’s Shulkin: Cerner rollout start by mid-2019?

An interesting short (free) article on POLITICO Morning eHealth today was an interview with VA Secretary David Shulkin, MD on the Cerner transition, stating that if all went well with negotiations later this year, VA clinicians could be using the Cerner system by mid-2019. “There’s a lot of understandable concern about whether the Cerner EHR will have the same functionality as VistA, which has evolved to the physician’s needs over the past 35 years.” One of the problems with VistA was that it wasn’t one system, it was 130 systems, which is echoed in many EHRs. POLITICO goes on to quote Dr. Shulkin: “I don’t hear as many concerns about that as I do relief about finally making a decision because people felt this was the slow death of a system that they have poured their hearts and souls into. Knowing we’re committed to doing a transition as well as we can is reassuring to people.” Sadly, the rest of the interview is paywalled on POLITICO PRO. Earlier analysis: VA says goodbye to VistA, hello to Cerner. We wonder what the involvement and engagement of the four Home Telehealth winners of the 5-year contract will be.

Cerner DoD deployment on time; Coast Guard EHR shopping; Air Force, VA sharing teleICU

The US Department of Defense announced that the deployment of Cerner’s EHR MHS Genesis at the Naval Hospital in Oak Harbor, Washington is on time for later this month. It’s a little unusual that anything this big and in the government is actually on time. It’s also meaningful for VA, as they are adopting MHS Genesis in an equally, if not longer, rollout [TTA 7 June]. Healthcare IT News

Less well known is the Coast Guard‘s dropping its costly six-year deployment of the Epic EHR last year and reverting to paper. They are not in the MHS Genesis rollout because the CG is part of the Department of Homeland Security, despite its service roots and structure similar to the US Navy. This has led to much speculation that their final choice will be DoD’s Cerner platform, although the OpenEMR Consortium has already answered their April RFI.

And even less noticed was the late June announcement that the US Air Force Medical Operations Agency and the VA are implementing a tele-ICU sharing arrangement, giving the USAF access to the VA’s capabilities at five AF locations: Las Vegas; Hampton, Virginia; Biloxi, Mississippi; Dayton, Ohio; and Anchorage, Alaska. The VA central tele-ICU facility is in Minneapolis. Doctors there can remotely consult, prescribe medications, order procedures and make diagnoses through live electronic monitoring. Becker’s Hospital Review, VA press release

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (updated)

The new sheriff just turned the town upside down. Veterans Affairs’ new Secretary, Dr. David J. Shulkin, as expected moved quickly on the VA’s EHR modernization before the July 1 deadline, and moved to the same vendor that the Department of Defense (DoD) chose in 2015 for the Military Health System, Cerner. VA will adapt MHS GENESIS, based on Cerner Millenium. The rationale is seamless interoperability both with DoD and with private sector community providers and vendors, which base their services on commercial EHRs. The goal is to have one record for a service member through his or her lifetime and to eliminate the transition gap after discharge or retirement. (Transition gaps are also repeated when reservists or National Guard are called up for active duty then returned to their former status.) Another priority for VA is preventing the high rate of suicide among vulnerable veterans.

Updates: VA confirmed that Epic and Leidos will keep the development of the online medical appointment scheduling program, awarded in 2015 and currently in pilot, to be completed in 18 months. The contract is worth $624 million over five years. Wisconsin State Journal  The House Appropriations subcommittee on Veterans Affairs likes the Cerner EHR change. The Senate Veterans Affairs Committee is meeting Wednesday to discuss the VA budget sans the EHR transition. The EHR numbers are expected to be sooner rather than later. POLITICO Morning eHealth 

Dr. Shulkin is well acquainted with the extreme need for a modernized, interoperable system serving the Veterans Health Administration (VHA), having been on the US Senate Hot Grill for some years as Undersecretary of Health for VA. The foundation for the move from homegrown VistA to Cerner was laid last year during the prior Administration through an August RFI for a COTS (commercial off the shelf) EHR [TTA 12 Aug 16] and in later hearings. “Software development is not a core competency of VA” and it has been obvious in system breakdowns like scheduling, maintaining cybersecurity and the complex interoperability between two different systems. To move to Cerner immediately without a competition, which took DoD over two years, Dr. Shulkin used his authority to sign a “Determination and Findings” (D&F) which provides for a public health exception to the bidding process. The value of the Cerner contract will not be determined for several months.

For those sentimental about VistA, he acknowledged the pioneering role of the EHR back in the 1970s, but that calls for modernization started in 2000 with seven ‘blue ribbon’ commissions and innumerable Congressional hearings since. He understated the cost in the failed efforts on interoperability with DoD’s own AHLTA system, VA’s own effort at a new architecture, and modernizing the outpatient system. This Editor tallied these three alone at $3 billion in GAO’s reckoning [‘Pondering the Squandering’, TTA 27 July 13]. 

It is still going to take years to implement–no quick fixes in something this massive, despite the urgency.

  • Both MHS and VA will be running two systems at once for years (more…)

Cerner’s takeoff delayed on DOD’s new EHR, MHS Genesis

The new $4.3 billion US Department of Defense EHR, jointly developed by Cerner and Leidos, has taken another delay from the aggressive rollout schedule set in April.  The original test start date was 6 December at the Fairchild Air Force Base hospital in Spokane, Washington (state) and the Oak Harbor Naval Hospital on Washington’s Whidbey Island. Back in early September, it was reported that it would be delayed by at least a few months for technical reasons (Federal News Radio and Healthcare IT News). The rara avis in the latter is a mention of major dental supplier Henry Schein–along with Accenture, they were part of the award, but very much a junior partner in providing the dental EHR. (Leidos release)

The latest update on the start of MHS Genesis is February 2017 for Fairchild AFB and June for Oak Harbor. Healthcare IT News

VA’s moves spell the end of the homegrown EHR

The Veterans Health Administration (VHA) is formally reaching out to the private sector to explore switching from its current, pioneering EHR system, VistA (also referred to as CPRS, Computerized Patient Record System) to a commercial system. Their ‘feeler’ is an August 5 and 8 notice in FedBizOpps.gov titled 99–TAC-16-37877 * RFI – VHA supporting COTS EHR REQUEST FOR INFORMATION (RFI), Solicitation Number: VA11816N1486. This requests information on business support for transitioning to a commercial-off-the-shelf system (COTS–don’t governments love acronyms?–Ed.) and closes 26 August, which is not a lot of time even for an RFI.

VHA has been under extreme pressure from Congress to modernize its EHR, lately in July hearings before the Senate Appropriations Committee. EHR replacement is also in line with the Congressionally-mandated, now concluded Commission on Care’s recently published recommendations on a total, top-down reorganization of VHA, including a sweeping reorg of their HIT management. The VHA strategy appears to be that while they are walking down the road to replace VistA and have already spent to assess where they are with KLAS and other EHR consultancies (spending $160,000+ on surveys), they are essentially ‘kicking the can down the road’ to the next administration (POLITICO’s Morning eHealth, 14 July).

Current state is to continue to upgrade VistA through late 2018, though the closely related Department of Defense’s Military Health System is in the long process of cutting its homegrown AHLTA over to Cerner-Leidos as MHS Genesis, awarded last August, with a first trial in the Pacific Northwest later this year (HealthcareITNews, Ed. emphasis). Of course, it will take the VHA years to roll it out; there are close to 9 million veterans enrolled in the closed system that is the VHA.  FCW, Morning eHealth 10 August

Love EHRs or hate them, the sheer size of the VHA and its growing concession that VistA won’t do in caring for American veterans makes it clear that the future of EHRs is in private systems from major developers–a field which is winnowing out to The Few (take that, GE).  (more…)

Paper beats the EHR rock, docs in British Columbia conclude

“Moving to an electronic system should enhance the care we provide, rather than jeopardize it.” “We do not want a catastrophic event to occur in order to have our concerns heard.” “We do not feel that it is ethical to put patients at risk using a system that makes it difficult to ‘do the right thing’ and much easier to make a significant error.”

Nine weeks into the launch of a C$174 million Cerner EHR in March, emergency room and intensive care unit doctors Nanaimo Regional General Hospital in British Columbia, Canada reverted to paper orders and instructions out of concern for patient safety. Internists and others wanted to do the same. They formed a 250-member Medical Staff Association, which had enough concerns to go on the record with a report that included the above. One example: the lack of confidence in the electronic ordering system module for diagnostic tests, drugs and patient instructions was enough for sixty-one Association members to vote unanimously on a  “no confidence” motion in the system and a return to paper orders. The report also detailed “a multitude of physician-reported major safety issues from every department that deals with acute patient care.”

The B.C. provincial health authority, which in Canada’s system can overrule doctors and parent companies (Island Health), won’t remove the offending module, but is concerned enough to order additional resources and ongoing refinements, based on physician concerns and recommendations from a recent internal investigation. Island Health’s board also asked the health authority to: address fatigue in clinical staff and medical professionals; adjust resources to alleviate workload burden; Improve trust in the electronic health record and associated clinical care processes; work collaboratively with clinicians and medical staff to evaluate improvements in the electronic health record for quality and safe patient care. Times Colonist (BC)

Our wrapup of news and tart takes on HIMSS 16 (updated redux)

Lions Lie Down With Lambs, and Other Miracles!

HIMSS 16’s main ‘breaking news’ centered on HIT interoperability. The lead was US Department of Health and Human Services (HHS) Secretary Sylvia Burwell’s announcement on how Lions Will Lie Down With Lambs, Or Else. 17 EHRs that cover 90 percent of electronic health records used by U.S. hospitals–including the bitterest of rivals, Epic (the EHR everyone likes to hate) and Cerner, 16 providers including the nation’s five largest private healthcare systems, and more than a dozen leading professional associations and stakeholder groups (including HIMSS) pledged to implement three core commitments that allegedly will improve the flow of health information to consumers and healthcare providers. They are consumer access, no information blocking and standards. When? Where? How? Strictly TBD. HHS release, MedCityNews, Modern Healthcare, which dubbed it ‘another year, another promise’.

Innovate or Die. For companies and providers, it’s not about compliance anymore but about improving patient outcomes due to value-based care and incentives. Providers will increasingly be responsible for patient care throughout the community to make their numbers. Having made this sound point, Dr John Halamka then proposes they will need a ‘care traffic control’ system through data aggregation, with a laundry list of ‘enablers’, directories and connectors surrounding the EHR. How this all will work together, and who will buy in already challenged practices and ACOs, plus how those 17 notoriously territorial EHRs will work with said ‘enablers’ — or complicators — is a mystery to this Editor. Pass the Advil, please. MedCityNews

Read on for more Top 10s, roundups, DOD and VA EHR news, the Super Bowl-winning quarterback tackles the closing keynote, and 10 ways you can become a HIMSS speaker! (more…)

Defense, VA EHR interoperability off the tracks again: GAO

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”175″ /] According to the US Congress’ Government Accountability Office (GAO), the birddog of All Things Budget, the Department of Defense (DOD) and Veterans Affairs (VA) missed the 1 Oct 2014 deadline established in the Fiscal Year 2014 National Defense Authorization Act (NDAA) to certify that all health data in their systems met national standards and were interoperable. Modernization of software–a new Cerner EHR for DOD, modernization of VistA– is also behind the curve with a due date now beyond the 31 Dec 2016 deadline until after 2018. Finally the DOD-VA Interagency Program Office (IPO), which shares health data between the departments, has not yet produced or created a time frame nor “specified outcome-oriented metrics and established related goals that are important to gauging the impact that interoperability capabilities have on improving health care services for shared patients.” iHealthBeat, GAO report