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…)

GreatCall enlarges remote monitoring profile with Healthsense acquisition (US) (Updated)

Updated. GreatCall, the older adult-targeted mobile phone/PERS company, on 20 December announced the acquisition of telecare/RPM developer Healthsense. Terms were not disclosed. Healthsense was one of the earliest developers (close after Living Independently Group’s, now Intel Care Innovations’, QuietCare) of a sensor-based residential system, eNeighbor, to monitor ADLs for activity and safety. It has been primarily marketed to senior living communities after an early start in home sales, and currently monitors 20,000 lives according to the press release. Healthsense acquired a similar system, WellAWARE, in 2013.

GreatCall is best known for its older adult-targeted mobile phone line, but in recent years they have expanded into mPERS services on phone and devices, including an emergency call center. The San Diego-based company acquired the remnants of the Lively in-home monitoring system a year ago and incorporated its watch-wearables into its medical alert product line.

This Editor speculates that one direction GreatCall may take is to expand into the senior community monitoring and home care business beyond mPERS. To date, GreatCall has been a highly successful, direct-to-consumer driven company which has popularized not only products to make technology simpler and more usable for older adults, but also led in a non-condescending approach to them. If the company decides to enter senior housing and home care, it presents a different and new marketing challenge, as both have been to date late technology adopters. Another concern is the cost/financial model, usability and reliability of Healthsense’s remote monitoring system.

The other direction is more conventional–GreatCall could incorporate the Healthsense technology and ADL algorithms into home monitoring, with a design resembling Lively’s original self-installed, attractively designed in-home telecare system.

Minnesota-based Healthsense in 15 years of operation raised what some would term a paltry $46 million of equity and debt financing in ten rounds (Crunchbase). Over this time, Healthsense’s investors were a small group, including New York-based Radius Ventures, Mansa Capital, West Health and Fallon Community Health Plan. After the $10 million venture round in 2014, the last investment was a small $2.6 million in February. Early investor Ziegler HealthVest Management, which purchased a significant interest in 2007, is not listed in Crunchbase’s roster, though one of their senior financial managers is on their board. This Editor senses (sic) that the investors were seeking to exit after a long time in.

The release has a summary of an earlier Healthsense study of interest to marketers of telehealth and telecare as a reference:

An independent 12-month study with Fallon Health (an investor–Ed.) found that using Healthsense remote monitoring in connection with Fallon’s model of care for seniors reduced total medical expenses by $687 per member per month — a nearly 16 percent reduction for pilot members as compared to a control group. The Fallon population using Healthsense demonstrated a 32.2 percent reduction in fees for inpatient hospital visits, a 39.4 percent reduction in emergency department costs and a 67.7 percent reduction in expenses for long term care vs. the control during the year-long study.

More in Mobihealthnews, MedCityNews, Minneapolis-St Paul Business Journal

(Updated with further information on early investor Ziegler and the senior housing market; hat tip to reader Andrea Swayne)