The Theranos Story, ch. 46: “F for Fake.” SEC’s fraud charges force Elizabeth Holmes out (finally).

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]Our New Year’s 2018 prediction (after December’s $100 million loan from Fortress Investment Group): “Ms. Holmes will be removed and replaced, then the company will be reorganized and/or renamed.”

Fortress did not have to wait long or get their hands dirty. Today, the Securities and Exchange Commission (SEC) charged both founder and now former CEO Elizabeth Holmes and past CEO/president Ramesh ‘Sunny’ Balwani with securities fraud. While Mr. Balwani will fight the charges, Ms. Holmes escaped trading her black turtleneck for an orange jumpsuit by agreeing to pay a penalty of $500,000 to the SEC, give back 18.9 million shares to the company, give up her uniquely Silicon Valley perk of super-voting equity rights, and is now barred from serving as a public company director or officer for 10 years. From the Theranos release: “As part of the settlement, neither the Company nor Ms. Holmes admitted or denied any wrongdoing.”

This penalty may seem puny in the light of other securities fraud cases, but it appears that Ms. Holmes took little salary out of the company, with most of her long-gone billions in presently worthless remaining stock. 

The exact meaning of fraud, as determined by the SEC in cases like these, is not casual. We can say that we never believed the Edison or miniLabs would work despite the press hype. We can observe that patients and doctors were misled in test results, resulting in major human cost (our Ch. 22).  The fraud here is directly tied to representations made to investors that enabled Theranos’ massive funding, in multiple rounds, of over $700 million between 2013 to 2015. These misleading representations included demonstrations, reports on the functioning of its analyzers, inflating its relationships such as with the DOD, and its regulatory status with the FDA.

It also does not matter that all the funds were privately raised. The SEC in its statement firmly stated that it will treat private equity as it does public when it comes to investments (pay attention, health tech companies): (more…)

BATDOK monitor jumps into action on the battlefield medic arm (USAF)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/09/BATDOK-on-Wrist-586×350.jpg” thumb_width=”200″ /]US Air Force researchers have developed software with the long handle Battlefield Assisted Trauma Distributed Observation Kit (BATDOK). It runs on a smartphone or other mobile devices, which (suitably ruggedized) can jump into action with medical pararescue and combat rescue Airmen. Equipped with medical sensors, “BATDOK is a multi-patient, point of injury, casualty tool that assists our human operators and improves care. It can be a real-time health status monitoring for multiple patients, a documentation tool, a user-definable medical library, a portal to integrate patient data into their electronic health records, and finally it is interoperable with battlefield digital situation awareness maps, which helps identify the exact location of casualties.” said the head manager, Dr. Gregory Burnett, of the Airman Systems Directorate in the Warfighter Interface Division of the 711th Human Performance Wing. Aside from the technology, the intriguing point of the story is how the development team literally jumped with USAF teams into hot landing zones, returned back to the lab, yet everything was validated through the design, integration and testing process by the Airmen in the field–a tip that our health tech software and hardware developers would be well advised to follow. This Editor hopes that this technology will quickly be commercialized for use by civilian paramedics. Armed With Science (DoD Science Blog)  (USAF photo)

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

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

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

TBI, early brain aging and a seismic analogy

Traumatic brain injury (TBI) has been receiving extra study in the past few years due to battlefield blast/IED injury as well as football and other sports injuries as early as junior high. The insidious nature of TBI is that long-term effects of accelerated brain aging can appear in those who have mild injuries, or who never experienced the usual symptoms indicating TBI such as dizziness, nausea and disorientation. Researchers have struggled for the reasons why “51 percent of sufferers of mild head injuries were reported as still having disability one year later at follow-up” and why a large proportion of military veterans who sustained mild brain injuries experience the heightened and uncontrollable emotionality of pseudobulbar affect (PBA). This article in the Genetic Literacy Project website works with an earthquake analogy: that there are P-waves (blast pressure) that compress tissues and disrupt neuronal communication, and in the long term accelerate brain aging and cognitive decline. Something sports injury, CTE researchers and research organizations within the military such as DARPA and DoD should be investigating. Hat tip to author and reader Dr Ben Locwin via Twitter.

An abundance of related reading in TTA can be found in searches under TBI and chronic traumatic encephalopathy. Also see our 2012 and prior archives for our writing on TBI.

Unnerving mergers (US-UK); DoD’s EHR picked; EHRs & AMA

Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.

Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.

Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later.  Leidos/Cerner announced as winners close of business Wednesday 29 July. 

In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management 

Possible early detection test for chronic traumatic encephalopathy (CTE)

A research study published today in the Proceedings of the National Academy of Sciences (US) presents the results of screening 14 retired professional American football players with suspected CTE. Using a tau-sensitive brain imaging agent, [F-18]FDDNP, the California and Illinois-based researchers were able to detect the abnormal accumulation of tau and other proteins, in the distinct CTE pattern, in the brains of living subjects who had received, during their playing careers, multiple concussions and head trauma. Of the 14, one had been diagnosed with dementia, 12 with mild cognitive impairment and one with no symptoms. Previous studies, such as Robert Stern, MD‘s pathfinding research at Boston University and for the NFL (see below), have been primarily post-mortem on brains donated for research, although Dr Stern’s last presentation at NYC MedTech and Inga Koerte, MD of the Ludwig-Maximilians-Universität München (LMU) have also used brain scan information on live subjects in their studies.

Where this differs is that the imaging agent injected binds to the tau  (more…)

Another go at a joint DOD-VA EHR? (US)

As this Editor was Pondering the Squandering last week of $28 billion HITECH Act funds meant to achieve EHR interoperability but falling well short, we recalled another Big EHR Squander: the integration of the Department of Defense’s (DOD) AHLTA with the Veteran Affairs’ VistA, an iEHR effort which collapsed in February 2013 at a mere $1 billion, in addition to dysfunctional or failed upgrades in both systems at just under $4 billion [TTA 27 July 13]. For civilians, this may not sound like much for concern, but for active duty, Reserve and National Guard service members transitioning from active to civilian status (and back as they are activated), often with complicated medical histories, it means a great deal.

At least one Congressman who also happens to be a physician, Representative Phil Roe, MD (R-TN) wants to try, try again. According to Politico’s Morning eHealth of last Wednesday, his bill will offer “a $50 million prize to the creator of an integrated military-veteran medical records system.” plus another $25 million over five years to operate it. DOD is moving forward with an $11 billion bid for a new EHR, but Rep. Roe’s staff issued a statement that differs with the DOD’s–that the new EHR still has no provision for secure and relatively seamless interoperability with the VA system to streamline the transfer of claims. We wish the best to Rep. Roe, and hope he can overcome Congressional inertia and two huge bureaucracies amidst doubts on the DOD’s EHR award process. FierceEMR on Roe bill, award process and adoption concerns by GAO and others. Also Anne Zieger in Healthcare Dive, iHealthBeat.

VA, DoD aren’t collaborating on EHR: GAO

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

EHR interoperability redux for VA, Department of Defense (US)

Back in late February, the US Department of Defense and Veterans Affairs announced that they would not achieve their goal of a single EHR by 2017, and would stick with their creaky AHLTA and VistA systems for the foreseeable future [TTA 3 April]–along with the general lack of interoperability–eyes rolled at the $1 billion down the drain, but seemingly not much else budged. (And this does not include the $4 billion spent on failed updates and fixes in both systems–TTA’s ‘Pondering the Squandering’, 27 July) To this Editor’s utter shock, the 2014 National Defense Authorization Act (NDAA), agreed to by the House and Senate this week, mandates a plan for either interoperability or a single system by 31 January–about 6 weeks from now–and to adopt it by 2016. Moreover, both systems must be interoperable with private providers based on national standards by 1 October 2014. A close reading of the NextGov article indicates that the bill adds levels of complexity and perhaps unworkability. Getthereitis, anyone?–or does this sound like Healthcare.gov, redux? FierceMobileHealthcare

And it takes a grad student to find a major info security flaw in VistA.  (more…)

Pondering the squandering of taxpayer money on IT projects (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has been in Observation Mode this week. But this handful of Dust-In-Eye necessitates a Benny Goodman-style Ray on another US governmental ‘fail’. When it comes to IT, the government admits…

Agencies Have Spent Billions on Failed and Poorly Performing Investments

Exhibit #1: FierceHealthIT summarizes five big ones out of a 51-page Government Accountability Office (GAO) report focusing on the inefficiency of agency IT initiatives–just in healthcare.

  1. Veterans Affairs (VA) VistA EHR system transitioning to a new architecture: terminated October 2010 at a cost of $1.9 billion
  2. VA-Department of Defense (DOD) iEHR integration: as previously written about, it collapsed under its own weight for another $1 billion [TTA 8 March]
  3. DoD-VA’s Federal Health Care Center (FHCC). Opened in 2010 as a joint facility under a single authority line, but somehow none of the IT capabilities were up and running when the doors opened. ‘Jake, it’s ChiTown.’ Only $122 million.

  4. DoD’s own EHR, AHLTA (no VistA–that’s VA’s) still doesn’t work right; speed, usability and availability all problematic. A mere $2 billion over 13 years.
  5. VA’s outpatient system is 25 years old. Modernization failed after $127 million over 9 years before the plug was pulled in September 2009

You’ll need Iron Eyes to slog through the detail, but it is a remarkable and damning document. PDF (link)

but…there’s more. Excruciating, hair-hurting, and would be amusing if not so painfully, and expensively, inept. Malware Removal Gone Wild at Commerce(more…)

VA distributing iPads to Family Caregivers (US)

Back in May 2012 we noted a Veterans Affairs (VA) program for 2013 that would distribute 1,000 iPads to primary caregivers of seriously wounded veterans to facilitate care delivery and data transfer. Then called ‘Clinic-In-Hand’, it is now officially debuting as the Family Caregiver Pilot for caregivers of seriously injured post-9/11 veterans already enrolled in VA’s Family Caregiver Program. The intent is now more clearly focused on reducing caregiver stress, via  pre-loaded apps to share health information, coach patients through chronic pain and PTSD and serve up tools such as reminders and a health journal. A second, the Veteran Appointment Request Web App Pilot, facilitates appointment setting via mobile or desktop PCs for a separate test group of 600 veterans and was launched at the Washington, D.C. VA Medical Center and VA Palo Alto (California) Health Care System. According to EHR Intelligence, if successful it will be rolled out to all patients at these two VA centers with a system rollout in the future–complicated by the fact that every VA center has a different scheduling system. Meanwhile, VA’s VistA and the DOD’s AHLTA still don’t talk to each other. VA integrates mHealth into daily care, gives iPads to vets (EHR Intelligence); VA Mobile Health release (for additional details go to the left hand drop-down menu). Hat tip to Contributing Editor Charles Lowe.

VA networks breached from overseas; 20 million records affected (US)

Department of Veterans Affairs IT systems have been breached since 2010 by eight ‘nation-state-sponsored organizations’, affecting records of 20 million veterans, according to recent testimony in hearings held earlier this month by the House Veterans Affairs Oversight and Investigations Subcommittee. While the normal ‘hack’ is due to theft or an inside job for financial gain, these likely have a far more sinister nature. According to former VA Chief Information Security Officer Jerry Davis (now at NASA), the attacks continue from these countries, and according to Subcommittee Chairman Rep. Coffman, may include China and Russia. Testimony and evidence also revealed that those responsible for informing Secretary Shinseki may have understated the problem. The VA has certainly been taking its lumps with a Magic 8 Ball of late, with a derailed joint EHR project with the Department of Defense and wrangling on who’s leading integration [TTA 3 April; iHealthBeat]. VA Systems Hacked From AbroadWas VA Secretary Misled About Breaches? (HealthcareInfoSecurity)

An ‘Office of mHealth’ a solution for FDA gridlock? (US)

The ‘FDA Office of mHealth‘ bill (H.R. 6626) as sponsored by Mike Honda, Silicon Valley’s House Representative (California 17th District), which expired with last year’s Congress [TTA 18 Dec] will be revived with revisions, according to MedCityNews. (Rep. Honda will be keynoting on the second day of MedCityNews’ ENGAGE conference in Washington D.C. in June.) Formerly dubbed HIMTA (Healthcare Innovation and Marketplace Technologies Act) will now include how that office will work with the alphabet soup of other agencies: FCC, HHS, ONC, FTC. It struck this Editor in December–and later [TTA 28 Mar]–that this bill does not go far enough. In its good intentions to speed mHealth approvals by creating a framework plus monetary incentives, it is not powerful or independent enough to slice through or bypass various turfs.  What would be revolutionary is simplification. Why not an independent unit that draws from FDA, FCC and HHS, but has priority and license to cut through red tape? But that would require major giving up of ground–and with this Federal Government, that ain’t gonna happen. Add to it that the most innovative work–and usage– is being done at DOD (DARPA, T2) and the VA, and the alphabet soup becomes goulash.  Wall Street Journal’s Venture Capital Dispatch

DOD, VA stuck behind the Magic 8 Ball: report (US)

Institute of Medicine, ‘Daily Show’ rap DOD, VA for unlinked EHRs

When the US Department of Defense (DOD) and Veterans Affairs (VA) announced back on 27 February that they would not achieve their major goal since 2009 of a single EHR system by 2017, with initial test next year, for this Editor it was just another billion-dollar ‘fail’ day out of DC. FDA dithers since July 2011 on final guidance on mHealth approval–yawn. Centers for Medicare and Medicare Services (CMS) cutting back rural telemedicine consults–business as usual. Individual health insurance premiums going up 30 percent next year? We knew that was coming! So no surprise here when the Institute for Medicine of the National Academy of Sciences issued a report highly critical of both agencies regarding the needs of 2.2 million Iraq and Afghanistan veterans, with one key criticism the lack of EHR interoperability. According to iHealthBeat:

The IOM report found that:
• 49% of returning veterans have experienced post-traumatic stress;
• 48% have dealt with the “strains on family life;”
• 44% have experienced readjustment difficulties; and
• 32% have felt “an occasional loss of interest in daily activities.”
According to IOM, the federal government’s response to troops returning to the U.S. “has been slow and has not matched the magnitude of this population’s requirements as many cope with a complex set of health, economic and other challenges.”

Neil Versel in his Meaningful HIT News article published yesterday highlighted the EHR single-system fail through, rather incredibly, a Jon Stewart Daily Show video segment called ‘Red, White and Screwed’. (Today, in American life, you know an issue has gone mainstream when it makes a ‘news/comedy’ show such as this or the Colbert Report.) This Editor is no fan for multiple reasons, but to his credit Mr. Stewart has been a strong advocate on behalf of veterans and showcases the failure of veterans’ support regularly on a segment called ‘The Red Tape Diaries’ without sparing a certain Administration from criticism.  Aside from over 900,000 veterans waiting an average of 273 days for their disability claims to be processed, the icing on the cake is how the EHR ‘fail’ was announced. At 3:20 in the video, a Government Accountability Office (GAO) official drily depicts both DOD and VA as perpetrators of project mismanagement and poor oversight. And this is despite a 40 percent increase in budget from the Republican-controlled House, which confounded Mr. Stewart. The criticism goes on from there. Magic 8 Ball says ‘messed up, try again.’  DoD-VA integration failure is no laughing matter, even to Stewart  Hat tip to reader Ellen Fink-Samnick, MSW of ‘Ellen’s Ethical Lens’ for featuring this article on her LinkedIn group. 

Related, ironic note: the DOD’s and VA’s EHRs are respectively called AHLTA and VistA, a nostalgic touch for those of us who used the first real search engine, AltaVista, circa 1996.