TTA’s Brrrrr Season 3: Oracle Cerner limps again, ransomware fizzles, research on blood microsamples and post-traumatic biomarkers, Dollar General clinics, Google antitrust, more!

 

 

Weekly Update

A potpourri of news this week from Google’s antitrust lawsuit (and 6% layoff) to Dollar General’s clinic pilot with DocGo mobile vans. Ransomware attacks by AlphV/BlackCat fizzled and the DOJ knocked out Hive. Significant research on microsamples of blood and post-traumatic biomarkers published. Oracle has more VA/MHS problems, engineering head departs. Some funding and grants. And did Elizabeth Holmes really attempt to flee the country?

Rounding out week: Oracle Health engineering head departs; Hive ransomware KO’d by DOJ; Google sued by DOJ on antitrust, lays off another 12,000; Pearl and Precision Neuro raise, Enabled Healthcare ADAPT grant
Mid-week news roundup: CVS Health Virtual Primary Care launches, VA’s two-day Oracle Cerner EHR slowdown, and microsampling blood + wearables for multiple tests (Not quite a return for the Theranos concept)
Healthcare cyberattack latest: NextGen EHR ransomwared by AlphV/BlackCat, back to normal – 93% of healthcare orgs had 1-5 ransomware incidents (Expect more of this–it’s a movable war)
Using wearables to monitor biomarkers related to neuropsychiatric symptoms post-traumatic event (Significant research)
Theranos Holmes trial updates: did she book a one-way flight to Mexico last year, or were the prosecutors reckless and wrong? (You decide)
CVS, Walgreens, Walmart….Dollar General health clinics? (A low-risk toe in the clinic water)

It must be Mid-Winter Blues, but the news was fairly light this week–even from the JPMorgan health conference, a soggy SFO affair indeed. (At least the streets were cleaned.) Babylon feels ‘misunderstood’, Teladoc lays off 6%. CVS keeps funding and KillNet keeps threatening IT Havoc. Good news from UKTelehealthcare with TECS help for the digital switchover. Plus ISfTeH’s annual meeting now set for Winnipeg and news from ATA.

Industry org news: ISfTeH International Conference call for presentations, new leaders for ATA Policy Council (Good news!)
UKTelehealthcare launches TECS consultancy in partnership with TECS Advisory (Expert help on the digital switch)
Interesting pickups from JPM on CVS, Talkspace, Veradigm backs Holmusk, ‘misunderstood’ Babylon Health; six takeaways (News from a damp, dreary, insane JPM)
Teladoc laying off 6%, reducing real estate, in move to “balanced growth” and profitability (Nice move if they can do it)
‘KillNet’ Russian hacktivist group targeting US, UK health info in Ukraine revenge: HHS HC3 report (Healthcare becomes a side battle)

A mulligan stew of a week. CVS moving in on primary care with (possibly) Oak Street, funding Carbon Health in-store clinics while the latter downsizes. Walgreens’ VillageMD closed on Summit Health and Teladoc paints a brighter revenue picture with BetterHelp. Rock Health quantified a deflated 2022 year in funding, but M&A/VC investment still proceeds in its ‘boring’ way. Verily, Alphabet’s wandering ‘bet’, finally gets a needed trim. And Theranos is still in the news from appeals to post-prison requirements.

Weekend short takes: Theranos’ Holmes post-prison mental health + more on Shultz and Balwani; global M&A, funding roundup
Rock Health puts a kind-of-positive spin on digital health’s ‘annus horribilis’ 2022–a boring 2023
Mid-week roundup: Teladoc gets BetterHelp to boost Q4 ’22 revenue; fundings for Array, Paytient, Telesair, three others; layoffs hit at Alphabet’s Verily, Cue Health
CVS works their plan in Oak Street Health buy talks, Carbon Health $100M investment + clinic pilot; VillageMD-Summit finalizes (updated)
Theranos trial updates: Holmes’ freedom on appeal bid opposed; Balwani files appeal to conviction

Two surprises not under the Christmas tree or New Year’s hat. The ITC upheld AliveCor patents and damages versus Apple, pending their PTAB appeal, and Amazon got its first state approval for One Medical. As expected, telehealth’s national Medicare reimbursement was extended for two years, setting policy for health plans. And NHS advanced rapid stroke diagnosis with Brainomix trial in 22 hospital trust trial, tripling near-full recoveries to 48%.

Weekend news roundup: GE Healthcare spins off, adds CTO; Allscripts now Veradigm; NHS Brainomix AI stroke trial success; Withings home urine scanner; Careficient buys Net Health EMR; CommonSpirit’s class action suit on data breach
Amazon-One Medical gains conditional OK in Oregon–a preview of coming scrutiny?
(What happens at the big state and Fed level?)
Telehealth extensions signed into US law with Federal FY 2023 omnibus bill (Major breakthrough to widen nationally reimbursed telehealth)
Split decision! ITC rules that Apple violated AliveCor patents; enforcement held for PTAB appeal (David v Goliath continues!)

A potpourri of news wraps 2022, starting with confirming how telehealth can stand on its own even in specialty care visits and its continued strength in mental health. In the US, most telehealth expansion is confirmed for two years. But as predicted, DEA is going hard after ADHD misprescribing — a unicorn may lose its horn as a result. Oracle is erasing Cerner’s home town presence as Epic stomps a patent troll. And beware of DDoS–it may distract from more nefarious cybercrimes.

We wish our Readers all the happiness of the season, as we look forward to the start of the New Year. We’ll be back with new articles after 2 January. 

We wish our Readers a happy, healthy holiday season and New Year!
News roundup: DDoS attacks may be ‘smokescreen’, DEA slams Truepill with ‘show cause’, telehealth claims stabilize at 5.4%, Epic squashes patent troll, Cerner meeting exits KC, MedOrbis, Kahun partner on AI intake (From cybercrime to Cerner, c-c-c-changes roll)
Telehealth two-year extensions included in US Federal ‘omnibus’ budget bill (Tucked into a Moby Dick-sized whale of a bill)
Few specialty telehealth visits require in-person follow up within 90 days: Epic Research study 2020-2022 (Findings, though, may be pandemically skewed)

Have a job to fill? Seeking a position? See jobs listed with our new job search partner Jooble in the right sidebar!


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

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Legrand/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. 


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

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Rounding out week: Oracle Health engineering head departs; Hive ransomware KO’d by DOJ; Google sued by DOJ on antitrust, lays off another 12,000; Pearl and Precision Neuro raise, Enabled Healthcare ADAPT grant

Oracle Health engineering executive VP Don Johnson ankles after six months. Mr. Johnson, who was a nine-year veteran of Oracle, came up through the cloud infrastructure area starting in 2014, after a previous stint from 2005 at Amazon Web Services. He led product strategy, engineering, and operations before shifting over to Oracle Health. Oracle’s Cerner acquisition has been one Tower of Trouble, a Mound of Misery, even before it closed last June. Being barked at by Congress and the GAO over the VA and MHS, plus eroding relationships with health systems over EHR problems, and with the pressure from the tip-top to fix it fast and get on with the transformation of healthcare, could lead one to consider a long trip to a Remote Pacific Island. The Register. Hat tip to HISTalk.

In one for our side, the Department of Justice (DOJ) announced that the international ransomware network known as the Hive was shut down. Its servers in Los Angeles and darknet sites were seized. The DOJ continues to pursue charges against Hive members. The Hive ransomware was used in attacks on an estimated 1,300 companies worldwide since June 2021, yielding about $100 million in ransom payments. Hospital systems attacked were numerous, including Memorial Hermann Health System in Houston and a Louisiana health system.   DOJ release 26 Jan, Healthcare IT News, HealthITSecurity

The problems at Google continue with a DOJ civil antitrust lawsuit released earlier this week accusing Google of monopolizing multiple digital advertising technology products. For those of us in marketing who came up with a choice of multiple search engines and ad technologies, Google’s monopoly of the “ad tech stack” that website publishers depend on to sell ads and that advertisers rely on to buy ads is very real, and very expensive. You live and die by Google algorithms on your search ranking, both natural search and optimization. In other words, you deal with Google or nobody. So the DOJ lawsuit, joined by eight states, is, in this Editor’s view, overdue. Few are drawing a line between this antitrust suit and the layoffs of 12,000 Google staff (6%) last week plus the cutbacks at Verily, but this Editor will. DOJ release, CNBC

Funding raises in seed, Series A and B are the most common–two of note in Series B this past week:

  • Pearl Health raised a $75 million Series B of $55 million in equity capital and an anticipated $20 million in a line of credit. The round was led by Andreessen Horowitz’s Growth Fund and Viking Global Investors. Pearl is a developer of services and software for independent providers to enable them to better participate in value-based care through consolidating healthcare data and then using that information to create personalized patient care plans.  Release, MedCityNews 
  • Precision Neuroscience raised $41 million, also in a Series B.  Precision is another brain-computer interface technology like Synchron [TTA 17 Dec 22], in this case focused on treatment of neurological illnesses and events such as stroke, traumatic brain injury, and dementia. Leading the round is Forepont Capital Partners. Mobihealthnews 

In even earlier-stage companies, grants from accelerators are still present and are significant. Enabled Healthcare is a startup that has received a grant of $50,000 from Village Capital’s ADAPT program, It is one of four receiving an equity-free, peer-selected grant. ADAPT, funded by MetLife Foundation, supports innovation and development of solutions for key issues related to climate change, healthcare and wellness, and economic mobility. Enabled was selected from over 130 startups. Enabled combines in-person and virtual monitoring approaches to better coordinate care for those with complex needs on Medicare and Medicaid, and will go live in March. Release 

Mid-week news roundup: CVS Health Virtual Primary Care launches, VA’s two-day Oracle Cerner EHR slowdown, and microsampling blood + wearables for multiple tests

CVS Health finally has Virtual Primary Care up and running. First announced by CVS last May, Virtual Primary Care provides primary care, 24/7 on-demand care, and scheduled mental health services to Aetna members nationwide enrolled in eligible fully-insured and self-insured commercial health plans. Members in VPC can schedule urgent care, 24/7 on-demand care (that may vary by plan), an in-office primary care visit, Minute Clinic visits, and expanded virtual mental health services. Amwell announced that it would be the provider in August on their Q2 2022 earnings call. The release mentions that board-certified physicians and nurse practitioners will be delivering primary care services through physician-led care teams and coordinating with CVS pharmacists. This applies to virtual mental health services as well. (One trusts that this in-network approach will avoid the problems they experienced with Cerebral and Done Health on their prescribed ADHD drugs.) Health records, lab results, and medications are shareable via the patient CVS Health Dashboard. At this point, there is no mention of further rollouts to other plans. Becker’s.

Somebody threw sand in the Oracle Cerner EHR gears at the VA–and it started at MHS. A report from the Spokane Spokesman-Review seems to be the only report out there (other than HISTalk picking it up) on the two-day slowdown in the Oracle Cerner Millenium EHR rolled out at the VA and the Department of Defense’s Military Health System (MHS Genesis) that covers active duty. On Monday and Tuesday, there was a “major slowdown” that did not abate until Tuesday afternoon.  It affected more than half of all MHS providers, as well as VA clinics and hospitals in Washington, Idaho, Oregon, and Ohio. Mann-Grandstaff clinicians reported problems to the Spokesman, which contacted the VA. Their press secretary Terrence Hayes confirmed that changes made to the system by the DOD, which shares a database with the VA, “had the unintended consequence of interrupting services that provide connectivity to the network.” The system slowed down from screen to screen, requiring clinicians to work extra time to make all entries, and was not resolved until configuration changes were made. This is another incident adding to a Very Large Dogpile, including interoperability between VA and MHS versions, 498 outages between September 2020 and June 2022, plus two veteran deaths.

And maybe Stanford, forever associated with Theranos, is trying to get its reputation back–in running multiple blood tests on microsamples. A new paper published in Nature Biomedical Engineering by a group of 17 researchers led by Stanford Medicine determined that valid tests could be run on a microsample (10 μl) of blood that could be drawn from a finger prick at home to test for thousands of metabolites, lipids, cytokines, and proteins. This testing would be paired with data captured from wearables. They tested reactions to food (Ensure shake) and the effects of physical activity on blood with wearables monitoring heart rate and step count, plus a continuous glucose monitor (CGM) to profile individual physiological status, including cortisol. Unlike Theranos, it’s not done in a ‘lab in a box’ in a supermarket trying to duplicate (fake?) existing diagnostic tests, and it employs mass spectrometry molecule-sorting technology in a lab. Becker’s.

News roundup: DDoS attacks may be ‘smokescreen’, DEA slams Truepill with ‘show cause’, telehealth claims stabilize at 5.4%, Epic squashes patent troll, Cerner meeting exits KC, MedOrbis, Kahun partner on AI intake

Readers won’t get out of 2022 without one last cybercrime…article. DDoS attacks–distributed denial of service–escalated worldwide with Russia’s invasion of Ukraine in February. (Ukraine and military aid is a hot topic this week with President Zelenskyy’s visit to the US and Congress speech.) Xavier Bellekens, CEO of Lupovis, a cybersecurity company and a cyberpsychologist (!), postulates that DDoS attacks, as nasty as they are, may be a smokescreen for far more nefarious and damaging attacks. While IT goes into crisis mode over the DDoS, other attacks and information gathering on systems preparing for future attacks are taking place. Russian cyber groups focus on large organizations and move down the line into the most vulnerable, using both manual and automated approaches. Worth reading given the vulnerability and IT short staffing in healthcare organizations. Cybernews

The fallout from Cerebral and Schedule 2 telehealth misprescribing expands. The Drug Enforcement Agency (DEA) issued a ‘Show Cause’ to online pharmacy Truepill for inappropriate filling of ADHD Schedule 2 medications, including Adderall. A ‘Show Cause’ order is an administrative action to determine whether a DEA Certificate of Registration should be revoked, which could put Truepill out of business. The red flag for the DEA: 60% of  Truepill’s prescriptions–72,000–filled between September 2020 and September 2022 were for controlled substances, including generic Adderall. Truepill was Cerebral’s primary mail order provider, though they also used CVS and Walmart. The company stopped filling Cerebral’s ADHD prescriptions in May 2022.

In the order, the DEA cites that “Truepill dispensed controlled substances pursuant to prescriptions that were not issued for a legitimate medical purpose in the usual course of professional practice. An investigation into Truepill’s operations revealed that the pharmacy filled prescriptions that were: unlawful by exceeding the 90-day supply limits; and/or written by prescribers who did not possess the proper state licensing.”

The company stated in an emailed statement that they were fully cooperating with the investigation. If it does move to a hearing, Truepill’s chances of a successful defense are statistically low.

Truepill also fills prescriptions for Hims & Hers, GoodRx and Mark Cuban Cost Plus Drug Company. It was valued in its 2021 funding round at $1.6 billion. Companies in telemental health and prescribing of Schedule 2 ADHD medications, such as Cerebral and Done Health, are under enhanced scrutiny over their business practices [TTA 1 June]. Mobihealthnews, DEA press release, HISTalk, Digital Health Business & Technology

Telehealth medical claims stabilize. FAIR Health’s latest reports for August and September report that the percent of medical claims coded as telehealth are back up to 5.4%. June and July dropped slightly to 5.2% and 5.3% respectively. Also steady are that the vast majority of claims are for mental health services. In September, they were 66% of diagnoses far ahead of ‘acute respiratory diseases and infections’ at 3.1%. In procedure codes, psychotherapy accounts for over 43%.

A patent troll Epically bites the dust. Back in the early to mid-2010s [TTA’s index here], patent trolls (technically non-practicing entities which have no active business) presented a significant threat to early and growth-stage health tech companies. One, MMR Global (which apparently no longer exists), was notorious for buying up EHR and PHR-related patents and then filing patent infringement lawsuits against both small and large healthcare organizations with similar patents–and their users–that were generally monetarily settled. But NPEs are still active. One in south Florida, Decapolis Systems, used the same techniques as MMR Global had, suing in this case multiple Epic customers for patent infringement. Epic not only defended its customers but also sued Decapolis in the US District Court, Southern District of Florida. The court found that both Decapolis patents were invalid, ending what Epic termed ‘vexatious patent litigation’. Decapolis had successfully sued 24 other entities, including other EHRs, which settled. Owned by an inventor, this company will have to find another line of honest business. Epic release, Thomson Coburg

Oracle’s message to Kansas City: no more Cerner meetings for you. And maybe more. Cerner’s site for its annual customer/partner conference since 2007 has been in Kansas City, attracting about 14,000 visitors. Not only will it be integrated into Oracle CloudWorld in Las Vegas, 18-21 September, it’s been retitled Oracle Health with no mention of Cerner. The loss to local KC business is substantial–estimated to be in the $18 million range. While it’s logical to integrate it into the massive CloudWorld conference, it’s also another message to KC after Oracle’s sudden real estate downsizing that Cerner’s presence there will shrink…and shrink..as it’s absorbed into Oracle Health, and further confirmation that the Cerner name is gradually being sunsetted. KansasCity.com, HISTalk

A new (to this Editor) specialty care telehealth company, MediOrbis, is partnering with Kahun for an AI-enabled digital intake tool. This is a chatbot capable of conducting an initial medical assessment. Based on the patient’s answers and Kahun’s database of about 30 million evidence-based medical knowledge insights, it provides a summary for the physician before the telehealth visit and highlights areas of concern. Mobihealthnews  MediOrbis also has partnered with remote care/engagement Independa to add its capabilities to Independa’s HealthHub on their LG TVs.

Oracle proceeds with $7B bond sale to restructure debt funding Cerner buy

As expected at end of October, Oracle is refinancing debt incurred to acquire Cerner. Bloomberg reported the bond sale is in as many as four parts. “The longest portion of the offering, a 30-year note, yields 2.55 percentage points above Treasuries after earlier discussions of about 3.1 percentage points, said the person, who asked not to be identified as the details are private.” The bridge loan (revised) of $11 billion was further reduced by $1.3 billion. Citigroup Inc., Bank of America Corp., Goldman Sachs Group Inc., HSBC Holdings Plc, and JPMorgan Chase & Co. are managing the bond sale.

Oracle has one of the highest debt loads in tech, exceeding $90 billion. Fitch Ratings has downloaded their bond rating from BBB+ to BBB overall, the next to lowest investment grade rating. The new notes were rated BBB by Fitch and S&P Global Ratings. An investment company queried by Bloomberg noted that as recently as 2020, Oracle’s debt was rated high A. Also Becker’s.

J.P. Morgan forms life sciences/healthcare VC group; virtual care Ovatient formed by MUSC Health, MetroHealth; Oracle’s putting lots of KC office space on market

Some more good news in healthcare–maybe a bit of spring in autumn?

J.P. Morgan is setting up a new venture capital team to invest in life science healthcare companies. The new group, Life Sciences Private Capital, will sit within J.P. Morgan Private Capital. Investments will be in early and growth-stage companies developing novel therapeutics and technologies in several target areas including genetic medicine, oncology, neurodegenerative disease, rare diseases, autoimmunity, AI/ML platforms, metabolic diseases, and neuropsychology. Heading the group is Dr. Stephen Squinto as Chief Investment Officer and Managing Partner. He joins from OrbiMed Advisors, and previously co-founded and built numerous biotechnology companies including Alexion Pharmaceuticals plus being a scientific founder of Regeneron Pharmaceuticals. Also joining are Dr. Gaurav Gupta and  Anya Schiess with experience at OrbiMed and Healthy Ventures respectively, as well as a prestige group of advisors. JPM press release, Becker’s

The Medical University of South Carolina health system (MUSC Health) and The MetroHealth System (MetroHealth) are partnering in a joint venture for virtual and in-home care. From the press release, Ovatient is designed to improve the care experience by linking patients to the delivery of virtual and in-home care via a platform that connects to health systems and acute or procedural care, eliminating fragmented care experiences. The JV also intends to sell the platform to other providers. Other health systems are either joining forces with virtual care providers and AI platforms or forming their own, such as NYC’s Hospital for Special Surgery with their RightMove virtual MSK spinoff, and Northwell Health. MetroHealth release, Mobihealthnews

And if you’re a company looking for luxe office space, Oracle’s putting a lot of it on the market. Granted, it’s in Kansas City, but it’s two buildings: the former Cerner World Headquarters in North Kansas City and a separately located Realization Campus in KC. Current onsite employees will be consolidated at the fairly new Innovations Center in KC by 30 November, which has a substantial 2 million square feet of space. The health clinic part of WHQ will close as well, but not the data centers–at least for now. (A gargantuan task!) Both WHQ and Realization, according to the Oracle Cerner thread on Reddit, have been largely unused since 2020, the pandemic, and Cerner’s transition to a hybrid workforce. Cerner had from 2021 been reducing KC-area office space which had been funded locally by $170 million in sales tax and revenue bonds. The downside is once moved, how many will remain? Oracle reportedly has been considering $1 billion in cuts and is busily refinancing its debt incurred by the Cerner purchase [TTA 27 Oct]. Ridding itself of empty office space is actually a good start, versus cutting heads–a bad move as Oracle tries to save Cerner at the VA and MHS. HealthcareITNews, HISTalk, KSHB 41

Oracle talks to banks to increase loans funding Cerner buy; VA delays Cerner deployments to June 2023

Oracle’s Cerner buy proving to be more expensive–and complicated–than expected. Oracle is reportedly going to its banks to increase their term loan against the Cerner purchase from the current $4.4 billion. The increase would refinance short-term debt and reduce refinancing of the existing bridge loan into longer-term bonds and loans. According to reports, the bridge loan, originally $15.7 billion of debt, was reduced to about $11 billion by the term loan. The bridge loan was originally used to finance the Cerner purchase.

Under the existing agreement, the term loan can be extended up to a maximum of $6 billion. This avoids the dicey situation the bond market is currently in with yields and access by companies.

According to Bloomberg Intelligence, Oracle’s over $90 billion in debt is one of the largest debt loads in tech. Oracle’s credit rating by S&P Global Ratings places it two steps above junk (Baa2/BBB/BBB+) but it may sidestep a downgrade by this action. Yahoo!Finance (Bloomberg), Becker’s 

Oracle announced last week modernizations to Cerner which would have greater interoperability and introduce more cloud-based features. This follows on Larry Ellison’s pronouncements during their September Q1 2023 earnings call. During the Oracle Cerner Health Conference last week, four were announced: Seamless Exchange (eliminating duplicate patient health information), Advance (dashboard), virtual models of care (virtual nurses capturing information), and RevElate (billing). Becker’s

Will the modernizations help Oracle’s VA migraine with the Cerner Oracle Millenium implementations? The prior week (13 Oct), the VA announced that deployments are being pushed from January to June 2023. The release cites the multiple problems with technical and system issues that were uncovered in August (outages), discussed extensively in Senate hearings in July, and the OIG report released in July on the ‘unknown queue’ and more.

Deputy Secretary of Veterans Affairs Donald Remy stated that “VA will continue to work closely with Oracle Cerner to resolve issues with the system’s performance, maximize usability for VA health care providers, and ensure our nation’s Veterans are served by an effective records system to support their healthcare. During this “assess & address” period, we will correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers.” VA will also concentrate on the existing five facilities already deployed on fixing the multiple issues they have. Veterans treated at these sites will receive letters asking them to call the VA if they experienced delays in prescription filling, appointments, referrals, or test results. One wonders if all the steps Oracle’s Mike Sicilia said Oracle is taking [TTA 28 July] to fix the performance, design, and functionality issues are achievable even in the longer time frame–and certainly in the five live systems.

News roundup: Oracle’s modernizing Cerner’s tech, but VA hedges training with AWS; Redesign Health’s $65M raise; Kyruus buys Epion Health; Zócalo Health raises $5M seed; Cigna Evernorth adds to digital formulary

Oracle’s Q1 2023 earnings call (Motley Fool transcript here) wasn’t much of a surprise. Earnings were up 23% to $11.4 billion. Cerner contributed $1.4 billion but was partly responsible for a 34% rise in operating expenses along with their business mix of our business. The Q2 forecast is 21% to 23%. But what should not be a surprise to anyone was the rapid Oracleization of Cerner’s tech. Answering a question about what value Oracle is delivering to Cerner’s products, Larry Ellison outlined that Cerner will have its first “pretty complete” health management product out within 12 months, using the Oracle Autonomous Database that runs itself without human labor, plus an all-new application development tool called APEX, a low-code tool. Ellison claims that the APEX low-code tool has security built into the tool, thus not requiring audits, and if the application fails, it rolls over into another data center and keeps running. In contrast, using standard methods, the product would take three to four years to build. Becker’s Health IT

The Department of Veterans Affairs (VA) is relying on Amazon Web Services for training services in transitioning from VistA to Cerner Millenium. The AWS programs will train VA Office of Information Technology staff in three areas: ENCOR implementation, operating Cisco enterprise network core technologies, architecting Amazon Web Services, and Red Hat System administration. The training will cost $54,000 over a base period of about two months. Becker’s Health IT

Redesign Health’s Series C racks up $65 million from General Catalyst, CVS Health Ventures, UPMC Enterprises, TriplePoint Capital, Eden Global Partners, Euclidean Capital, Declaration Partners, and Samsung Next. Redesign is an unusual enterprise that creates startups from its own research, assembles management teams, brands, and funds them. Since 2018, they have created 40 healthcare startups. The funding will be used not for funding additional startups but to expand Redesign’s capabilities in startup creation. Some of their startups: Ever/body (cosmetic dermatology), Calibrate (weight loss, which brutally lost a quarter of the company in July), Jasper (cancer care), Vault Health (virtual diagnostics), and MedArrive (EMS dispatch). Fast Company, FierceHealthcare.

Kyruus adds patient engagement to provider search with Epion Health buy. Kyruus, headquartered in Boston, connects providers in healthcare organizations with people needing the right care, as well as for organizations to maintain provider information and data management. Epion Health, headquartered in Hoboken NJ (near NYC), developed a platform to connect patients with their providers including services such as online check-in, telehealth, integrated reminders for scheduling, and patient education. The acquisition expands Kyruus to 500 health systems and medical groups. Terms and management transitions were not disclosed. For Kyruus, which acquired patient navigation too. HealthSparq from investor Cambia Health Solutions, this helps them build out an end-to-end provider-patient platform. Kyruus release, Mobihealthnews

Startup Zócalo Health raised seed funding of $5M to launch virtual healthcare in California, Texas, and Washington. Zócalo (Spanish for plaza or town square) will offer in those states “virtual first family medicine service designed by Latinos, for Latinos”. Already operating in California, Texas and Washington will be added by end of year. Promotoras de salud will serve as health coaches to their patients. Mobihealthnews

Cigna’s health services/tech arm, Evernorth, announced that it is adding two digital health apps to its formulary: UK/US Big Health’s Sleepio for insomnia and Daylight for anxiety, Quit Genius’ alcohol use disorder and opioid use disorder programs, and HealthBeacon’s injectable medication adherence tool for inflammatory conditions. They also announced pilot programs for Jasper Health (Redesign Health, above), Zerigo Health for psoriasis and eczema, Hinge Health’s new women’s pelvic health program, and Lid Sync’s medication adherence tool. Mobihealthnews

Week-end news roundup: Allscripts on the acquisition hunt, Amwell’s CVS telehealth deal, Cerner’s $1.8M racial discrimination settlement, predicting Parkinson’s progression via smartwatch data

Another company on the hunt for strategic buys. Health IT and EHR company Allscripts is seeking to add to its Veradigm analytics, research, and provider/payer platforms with some strategic acquisitions. Announced on its Q2 earnings call by new CEO Rick Poulton is the intent to expand the company from its current provider base into a more diverse one serving payers and life sciences. Allscripts does have some free cash–about $700 million–having recently sold its hospital and large physician practice EHRs to Constellation Software/N. Harris Group, though there were some settlements around their Practice Fusion EHR now incorporated into Veradigm [TTA 2 Apr]. With a free cash flow from continuing operations around $120 million and about 7% growth, they feel the time is here for some accretive, strategic, and proven acquisitions–at the right price. FierceHealthcare

Amwell’s Q2 earnings call also had good news for shareholders, who of late haven’t had much to cheer. CEO Ido Schoenberg, MD announced that Amwell will provide CVS Health’s Virtual Primary Care, formally launched in late May  Amwell will be providing primary, behavioral health, and chronic care management through the platform. CVS will be providing these services to Aetna fully-insured, self-insured plan sponsors, and CVS Caremark clients effective first half 2023. As this Editor wrote earlier this week, CVS Health is making no secret of its intent to expand into delivering primary care and home health. One way Virtual Primary Care will be leveraged is converting in-store health services to virtual, such as non-emergency treatment and nutrition/wellness programs. CVS is even dabbling into blockchain with downloadable non-fungible tokens (NFTs) for virtual services. HealthcareFinance 

Cerner, on the other hand, is paying out $1.8 million to settle a racial discrimination lawsuit brought by the US Department of Labor. As a Federal contractor, Cerner went under review by the Office of Federal Contract Compliance Programs. That office alleged that Cerner systematically discriminated against qualified Black and Asian applicants who applied for positions at five facilities in Missouri and Kansas between 2015 and 2019. Cerner agreed to pay $1,860,000 in back pay and interest to 1,870 applicants in areas such as medical billing, system engineers and technical solution analysts. Certainly Oracle wanted to get this off the plate before the cutover on 1 October. HealthcareFinance, Department of Labor release

Can enough data collected build a predictive model for the progression of  Parkinson’s? Koneksa, a digital biomarker builder, is working with the Michael J. Fox Foundation for Parkinson’s Research to build a predictive model on how Parkinson’s will progress over time in an individual. The Fox Foundation already has a database to analyze — the Parkinson’s Progression Markers Initiative, launched in 2010, with health information and biosamples from Parkinson’s patients. Added to this will be data from Verily’s smartwatch:  activity tracking, gait analysis, and sleep cycles, which will be analyzed using Koneksa’s algorithms and additional machine learning. The award by the Fox Foundation was not disclosed, but it is the second for Koneksa after another grant awarded in mid-June to analyze vocal abnormalities relating to early progression of the disease, in conjunction with Northwestern University. FierceHealthcare

Oracle’s Big Vision will be missing a lot of people; layoffs hit Cerner, customer experience, marketing staff

‘Healthcare Transformation’ will ring hollow for the many employees at Oracle and Cerner who will be getting 60-day notices — or less — to depart.

One group is within Oracle in the US customer experience division and marketing, and apparently more. According to Bloomberg, the customer experience area that provides analytics and advertising services had been lagging for some time and has been reorganized, losing in the process junior sales employees, a division sales director, and marketing positions. Numbers are not provided, nor information on severance. Also Becker’s.

On the Oracle thread on TheLayoff.com, Oracle Cloud Infrastructure (OCI) North America has been substantially downsized effective 15 August, especially those supporting a Startups product. 

More extensive are the Cerner cuts. This Editor has been following postings as they happen on both the Reddit r/cernercorporation and TheLayoff threads (Oracle thread here). Areas mentioned appear to be primarily internal/non-customer facing: technical project management in population health, enterprise change management, enterprise process improvement, multiple VPs, sales engineers, application services/support, marketing (of course), talent acquisition, and other areas. People ranged from new hires who had offers pulled, to those under one year, to highly experienced employees with a decade or two in the company. UK tech site The Register has an estimate from one posting of 10,000 layoffs. Given that Cerner has about 20,000 employees, that is close to 50%.

As is typical of mass layoffs, those at Cerner reported that they were notified en masse by managers on Monday through snap meetings. Their packages were cleverly designed to skate through the 60-day WARN notice to the state in the US, providing for an end date in 60 days, just before the official cutover to Oracle on 1 October. Severance packages without insurance or benefits after the 60 days were two weeks for every year at Cerner, not particularly generous given the uncertain economy and freezes all over tech. If the individual sought and was offered a position at Oracle, the severance package would be pulled, which is the usual maneuver to discourage any internal job-seeking from this group.

There is no indication of any cuts to Cerner outside the US, yet. The Independent, citing The Information, indicated that further Oracle cuts may come from Canada, India, and Europe. Oracle has a goal of saving $1 billion.

In this Editor’s view, Oracle is erasing Cerner as fast as it can [TTA 19 July] and doing internal housecleaning (bloodletting) at the same time. As to the former, Mike Sicilia’s testimony to the Senate committee about Cerner at the VA [TTA 28 July] had a distinct tone of cleaning up the previous regime’s mess–this should be no surprise. Yet Cerner’s tippy-top management remains in place, with generous compensation and separation arrangements in place [TTA 19 July with links to prior articles]. Cerner’s healthcare customers should take note, either way.

Having been there and done that more than once, our best wishes to everyone affected. Remember that you are not your job, pack up your learnings in your kit bag for a new journey, and you will land a good job soon.

Hat tip to HISTalk as well for covering this story and reaching many on the provider and partner side in the industry that we do not.

Oracle’s ‘new sheriff’ moving to fix Cerner EHR implementation in the VA: the Senate hearing

Last week’s (20 July) hearing on the VA’s increasingly wobbly EHR transition from VistA to Cerner showcased Oracle’s executive vice president for industries Mike Sicilia. His testimony to the Senate Committee on Veterans’ Affairs had a heaping helping of ‘the new sheriff has arrived in Dodge City’.  As of six weeks ago, after the Transformational Big Vision kvelling faded, Cerner’s painful stumbles became Oracle’s VA Migraine [TTA 21 July, 21 June]. Cerner is now part of the Oracle Global Health business unit that falls under him.

First, the pledge made in his statement: “Unlike Cerner alone, Oracle brings an order of magnitude more engineering resources and scale to this formidable challenge.” After outlining the work that Oracle has done for CDC and NIH on Covid-19, he testified:

You should consider that in effect the VA, the Department of Defense (DoD) and the Coast Guard obtained a new, vastly more resourced technology partner overnight to augment Cerner. We also strongly believe in this mission and consider it not only a contractual obligation but a moral one to improve healthcare for our nation’s veterans and their caregivers. We intend to exceed expectations. 

Of the list of 36 issues detailed by the committee to VA Deputy Secretary Remy, Sicilia condensed them into three main areas: performance, design, and functionality. The concrete moves are:

  • Oracle will move the implementation to the cloud and rewrite Cerner’s pharmacy module, completing both tasks within 6-9 months
  • They have set up a ‘war room’ consisting of Oracle’s top talent of senior engineers and developers, working on the entire DoD/VA EHR systems as priority #1, with the first order of work a top-to-bottom analysis. While integrating with the Cerner team, the statement makes it clear that Oracle “brings an order of magnitude larger engineering team than Cerner”.
  • The Cerner EHR system is currently running on a dated architecture with technology that is in some cases two decades old and thus will be moved within 6-9 months to Oracle’s Generation 2 cloud. (That must be reassuring to thousands of hospitals and practices!)
  • Shortly after the closing, Oracle fixed a database bug that caused 13 of the last 15 outages, and as of last week there were no further outages. 
  • Testifying on the status of the “unknown queue”,  he stated it was designed to account for human error rather than to mitigate it, so it will be redesigned–it will be automated more on the front end and on the back end will have a better process.
  • Oracle will “start over” with the Cerner pharmacy module, rebuilding it as a showcase of a cloud-optimized web application.

VA’s EHR leaders also testified at the Senate hearing. Terry Adirim, Executive Director of the Electronic Health Record Modernization Integration Office at the VA, confirmed that unsurprisingly, Cerner’s next rollouts scheduled for the Boise VA Medical Center and other centers have been postponed indefinitely due to multiple ongoing system stability issues: change control and testing; challenges with increased capacity; basic functionality; its resilience design, and its response in last resort disaster situations. These specific issues overlapped but were more specific than those covered in Sicilia’s statement, which focused on the actions that Oracle would take.

Adirim and Kurt DelBene, the VA’s CIO, were roasted by the senators as painting a “very rosy picture”. The OIG report itemized at least 60 recommendations before going further. Adirim, to his credit, noted that DoD had similar stability issues in its system which was a warning, but the VA’s system is far more complex and care oriented than DoD which presumably exacerbated those issues. FedScoop and especially HISTalk’s Monday Morning Update 7/25/22

VA’s final, troubling OIG ‘unknown queue’ report on Cerner Millenium rollout; Oracle’s Sicilia to testify before Senate today

The Office of the Inspector General (OIG) report on the troubled rollout of Cerner Millenium at the VA continues to reverberate. The final report, revealed last month in draft [TTA 21 June], detailed a flaw in Cerner’s software that caused the system to lose 11,000 orders for specialty care, lab work, and other services – without alerting health care providers that the orders (also known as referrals) had been lost. This was the infamous ‘unknown queue’. The final report identified 149 adverse events related to the lost orders, including a homeless veteran at risk of suicide whose follow up appointment was lost, threatened to kill himself, but fortunately was helped (and hospitalized) outside the VA system. None of these problems surfaced before the go-live at Mann-Grandstaff VA Medical Center, but did four days later–and apparently other end users weren’t informed of the problem until a year later.

In FierceHealthcare’s update published today, “The OIG called it “troubling” that the deputy secretary [Donald Remy] “appears to absolve Oracle Cerner for its failure to inform VA of the unknown queue while placing the blame for outcomes from the unknown queue on VHA end-users.”” and “In a second report (PDF) released last week, the federal watch agency says VA project executives misrepresented its EHR training program” starting with Mann-Grandstaff. Two VA senior staffers responsible for training employees there gave inaccurate data to inspectors.

Cerner Millenium and the VA implementation (and other problems around the DOD implementation) are now Oracle’s headache. Executive Vice President Mike Sicilia was scheduled to testify Wednesday afternoon at a Senate hearing this afternoon to answer the many questions raised about the EHR rollout and safety problems. 

Cerner’s business now consolidated under Oracle Health

The internal memo doesn’t say so but doesn’t really have to. The sunsetting of the Cerner brand (logo left) has begun. HISTalk this evening reported on Friday 15 July’s Cerner internal announcement posted on Reddit, vetted by the Kansas City Business Journal (paywalled), and it’s not all that surprising:

  • The business unit is now called Oracle Health Global Industry Unit (GIU) or Oracle Health
  • The chairman of Oracle Health will be David Feinberg, MD, late CEO of Cerner and previously of UCLA Health, Geisinger Health, and Google’s last effort at Health. 
  • Travis Dalton is being promoted to run the Oracle Health GIU as General Manager from running Cerner Government Services as Client Services Officer
  • Cerner’s engineering and product executives will be reporting to Oracle’s Don Johnson who runs all Oracle engineering for all applications and platform services. This includes former CTO Jerome Labat who received a stay deal along with Dr. Feinberg [TTA 21 Jan, 26 Jan]. Mr. Labat has at least 11 million good reasons (and Dr. Feinberg 22 million) to stay for the next year and a day from the closing on 8 June.
  • Cerner’s corporate functions, such as IT, finance, legal, and HR, will move into Oracle’s centralized, global teams, which typically means that pink slips will be the order of the day if they haven’t already been received
  • More disclosed to employees at a town hall on that Friday 
  • No external announcement has been made as of 1845 19 July (Eastern Time)

Our Readers who have been following the acquisition and personally been through acquisitions know the stage was set by Larry Ellison’s Big Pronouncements on Healthcare Transformation at the closing [TTA 14 June]. It was all about what Oracle would be doing in building a national health record database and more, with nary a mention of Cerner. The eventual elimination of the Cerner name should thus be no surprise to industry observers. Cerner was a pearl bought at a great price ($28 billion) to make Oracle the Visionary Leader In Healthcare and provide Mr. Ellison with a Grand Finale.

How this will be received by health system and provider customers–including DOD and the ever-troublesome VA–is anyone’s guess. This Editor has previously speculated that health systems with Cerner EHRs were not going to be enthusiastic about replacing Cerner’s current third-party vendors with Oracle services and technology, especially if they worked well or if Oracle costs more. If the move to OCI–Oracle Cloud Infrastructure–doesn’t go as smooth as brand new glass, another black mark in the copybook. The other would be resentment of Oracle’s announced and completely expected hard sell on other services to make up the cost of the pearl. [TTA 15 June]

Almost an ideal scenario for Epic to sell against, one would think. As for the VA, Oracle needs to fix the Cerner Millenium rollout now under heavy scrutiny–fast and right.  

Wednesday news roundup: Oracle scrutinizing outside vendors, cloud change coming for Cerner EHRs, audio-only telehealth can continue after PHE–HHS, Proximie connected surgery raises $80M (UK)

Oracle moving quickly to change Cerner’s outside vendors to Oracle products and move their EHRs to Oracle cloud services. Will this fly with health systems and providers? An immediate change that will resonate with current Cerner EHR users is Oracle’s immediate moves to replace Cerner’s current third-party vendors with Oracle services and technology. So if your Cerner EHR has something you like but it comes from a third-party vendor, enjoy it while you can. Do expect that Oracle will be selling other products like Enterprise Resource Planning Cloud, administrative systems, and supply chain into providers and health systems–hard. From the earnings call, CEO Safra Katz: “We remain confident in our ability to grow Cerner’s top line and bottom line faster than they were able to do so on their own as these changes are implemented.”

The major and quickest move specified in yesterday’s Oracle earnings call (transcript) will be to move Cerner to OCI–Oracle Cloud Infrastructure. Further down into Mr. Katz’s remarks, Cerner is expected to account for 20 points of their cloud growth in Q1 2023 (starting 1 June 2022). When Cerner has added $15.8 billion of debt to the balance sheets, it’s to be expected.  HISTalk, Becker’s

What happens to audio-only telehealth at the end of the pandemic Public Health Emergency (PHE)? HHS has just issued guidance that will permit telehealth, including audio-only, services to continue. According to the HHS release, “HIPAA covered entities can use remote communication technologies to provide telehealth services, including audio-only services, in compliance with the HIPAA Privacy Rule. ” There are specific requirements such as how the HIPAA Security Rule applies to electronic media and electronic protected health information (ePHI). The full guidance is here.

UK surgical connectivity platform Proximie raises $80 million. London-based Proximie, a system that connects surgeries with pre-operative patient information, collaborative tools, and post-operative content distribution, completed a Series C with participation from Emerson Collective – the impact investor founded by Laurene Powell Jobs, SoftBank Vision Fund 2, British Patient Capital, Mubadala Investment Company, and the Minderoo Foundation, plus previous investors. The raise is unusually large (in this Editor’s opinion) for the UK, particularly at this uncertain time. Proximie has supported over 13,000 surgeries in 100 countries, contracts with over 35 major medical device companies such as Stryker and Abbott, and has been used in 500 hospitals across 50 countries. The company is a partner with Teladoc and Vodafone Business.  Release.  

A sneak peek at Oracle’s plans for healthcare prior to 9 June’s ‘The Future of Healthcare’ live

Gimlet EyeOracle is all set to heal the healthcare system, now that Cerner’s in the fold. Unlike other companies that have promised (ZocDoc and Change Healthcare come to mind), Oracle may actually have the capabilities to do so in many areas. Oracle has the enterprise infrastructure, the analytics, and IT automation; Cerner brings the entreé into patient records, automation, and clinical expertise that Oracle on its own didn’t have.

For those Readers not able to join the Oracle Live presentation at 3pm Central Time, 4pm Eastern, and 9pm BST (and miss Tony Blair! s/o), some of the highlights of the preview posted by Oracle’s EVP Mike Sicilia, on the Oracle Health blog:

  • The objective is to deliver “secure and reliable solutions that deliver health insights and experiences to dramatically change how health is managed by patients, providers, and payors”
  • Reduce technology-induced administrative burden that’s burned out clinicians through “a toolset that supports clinical decision making and prioritizes the user experience” via an interface that’s easy to use for care delivery organizations to find patient information
  • Make systems interoperable between organizations so that clinicians can access complete medical histories and records are portable by the patient by creating a collaborative ecosystem that breaks down information silos
  • Using their Fusion application to streamline and integrate back-office systems to drive efficiency and reduce costs, as well as reducing administrative costs, the supply chain, and retaining employees
  • Oracle’s 40+ years in securing vulnerable healthcare data to the standards they have in handling large volumes of cloud-based data for financial institutions
  • Combining existing expertise in areas such as clinical trials, health insurance, and public health analysis with Cerner, they will “support the entire lifecycle of healthcare, going beyond traditional health IT to integrate our infrastructure, platform, and applications capabilities for a more fully connected operational, administrative, and clinical system”

Those cynics among us with Gimlet Eyes have heard each and every one of these points before. Panaceas where everything is there for everybody, all wrapped up with a blue bow, if you buy it all at the usual stunning price, have been tried before in healthcare. Another question is the mesh of Middle America Cerner and Silicon Valley Oracle. Nonetheless, the combo should give the industry a little hope. They’ll be feeling their way through as Cerner is an organization used to doing things their way. If Oracle can straighten out the MHS Cerner Genesis and Cerner Millenium rollout in DOD and the VA, it’ll be worthy of applause.

Wednesday AM roundup all about money: $28B Oracle-Cerner closes today, 9 June strategy talk; Teladoc class-action lawsuits begin; Cigna’s look at loneliness

As you read this, Oracle has closed on their acquisition of Cerner Corporation. According to the Oracle release, approximately 204,280,589 shares, or 69.2% for $28 billion, have been validly tendered and other conditions, such as passing antitrust approvals, have been satisfied. If there are other loose ends to tie off, they aren’t impediments to the closing.

Interested Readers can register to hear Larry Ellison, Oracle’s chairman, and other speakers outline Oracle’s strategy to “redefine the future of healthcare” (a song we’ve heard before) on 9 June at 3pm Central Time. If our UK Readers have been wondering what former PM Tony Blair’s been up to, he’ll be on this call. Other UK speakers are David Walliker, chief digital officer of Oxford University Hospitals, and Kevin Jarrold, joint CIO of Imperial College Healthcare. Another outside speaker is Meharry Medical College‘s CEO, James E.K. Hildreth, MD, PhD. Meharry, located in Nashville, is the second oldest medical school founded (1876) to educate black Americans in medicine and dentistry.  

Here we go with class-action lawsuits against Teladoc based on loss of share value and misleading statements. Teladoc, whose stock has taken a long jump off a very tall building (90% loss from the high), is being sued in US District Court for the Southern District of New York by a shareholder, Jeremy Schneider. This is a Federal securities class-action lawsuit (text here) with Mr. Schneider representing shareholders who purchased Teladoc shares between 28 October 2021 and 27 April 2022 (the date of announcing Q1 2022 results). The charges involve materially false statements that Teladoc made on its business, operations, and prospects including minimizing competition leading to increased advertising costs, unrealistic projections for revenue made in the period, and the impact of the Livongo writeoff announced Q1–a noncash goodwill impairment charge of $6.6 billion, or over $41 per share [TTA 4 May recaps Q1].

A lookup on Justia indicates that Mr. Schneider is being represented by Jeremy Alan Lieberman of Pomerantz LLP. The filing names Jason Gorevic, CEO, and Mala Murthy, CFO as individual defendants along with Teladoc. Mr. Schneider is not a large shareholder; his investment was a little over $250,000 from December 2021 to February 2022. Other shareholders may join the suit by contacting Pomerantz.

What usually happens after this is other firms file class-action suits in the same court representing other shareholders. An example of this trolling is this announcement/release from Bernstein Liebhard LLP

If you like risk and volatility, TDOC and AMWL shares remain relatively cheap (the latter below $5) and haven’t recovered. TTA reflected on Amwell’s equally shaky Q1 and growing losses in May 

If and when they’ll recover is anyone’s guess, with increased direct-to-consumer competition from retail (CVS, Walmart) and with providers maintaining their own telehealth systems, homegrown and whitelabeled (Bluestream Health, Zipnosis). Healthcare Dive, Mobihealthnews recap much of what led to this point.

If you feel a little lonelier after your Teladoc (or other telehealth) shares tanked, or you feel like life hasn’t gotten back to normal now that the pandemic is really over (despite the hoo-hah over monkeypox), Cigna’s latest research commissioned from Morning Consult will be on point. Isolation is a function of lower income, lower physical and mental health, and being a single parent or mother. Contrary to the usual assumption, young adults 18 to 24 feel lonelier and more left out (79%) compared to those aged 66 and over (41%). (Your Editor speculates that the office and workplace are more necessary for socialization by those starting their careers than those toward the end who’ve built their networks.) What’s also a little surprising is the increased indication of loneliness among racial lines with black/African American (68%) and Hispanics (72%) feeling significantly lonely. The impact at work is less productivity and more unhappiness with their jobs. The study recommends increases in work and community activities, work flexibility, improved benefits, and workplace inclusion. A bit more along with quotes from Cigna’s Evernorth subsidiary in FierceHealthcare