VA pulls out the stick in contract renegotiation with Oracle Cerner, slams brakes on further EHRM rollouts–and is this trouble? (updated)

April 19, 2023 | by

VA puts away the carrot, pulls out the stick with Oracle Cerner on the VA EHR modernization. Last Friday’s report in the Wall Street Journal (paywalled) confirms that the Department of Veterans Affairs (VA) is actively renegotiating its contract with Oracle at what is now the five-year mark. Until an agreement is reached, VA is pausing the rollout, which according to previous reports has been largely paused anyway due to multiple critical problems in the slow rollout to date. The WSJ report is cited in Becker’s.

Reports in March during Senate VA committee hearings indicated that the $16 billion contract was due for renegotiation anyway by 17 May. Typically, VA vendor contracts are for five years and the original contract was signed in 2017 with Cerner. VA’s contracting officer, Michael Parrish, testified in those Senate hearings that he will push for a more favorable contract [TTA 18 March].

The Oracle Cerner Millenium EHR was to replace the crusty, still working but not interoperable VistA EHR. The Department of Defense had already contracted with Cerner and Leidos to develop an EHR for the Military Health System (MHS), Genesis, replacing AHLTA. That has largely been completed in a smaller system, though not without its glitches. Billions had been spent in multiple multi-year efforts to make the two existing systems interoperable, for instance to cover records of service members transitioning from active service to reserve or veteran status and for military retirees.

Oracle closed its $28.4 billion acquisition of Cerner last June to much fanfare, but has not had a pleasant moment with the VA or Congress since. During 2021-22, failures of the Oracle Cerner system included hundreds of outages, the ‘unknown queue’ creating at least 150 instances of harm (including one averted suicide) at one VA health system (Mann-Grandstaff), four veteran deaths, training program troubles, more in a GAO Inspector General audit, and the VA’s EHRM Sprint Team itself identifying 14 main and multiple sub-issues in safety and medical research integration in the EHR Modernization Sprint Report (PDF) released on 10 March delving deeply into the initial implementations. 

In 2023, there have been three Senate and three House bills proposed with mandates ranging from ‘hold rollout till issues fixed’ to ‘pull the plug and start over’. The VA had two resignations tied to the EHRM failures, VA deputy secretary Donald Remy and EHRM director Terry Adirim, MD. Implementations were delayed at Michigan’s Ann Arbor (including medical research, TTA 1 Mar) and Saginaw (this month) systems to later this year or even 2024. None of this has been cheap. The Senate VA Committee hearings in March revealed that the VA has paid Oracle Cerner $4.4 billion on the contract so far, with a refund of $325,000 paid as compensation for ‘incomplete technology and poor training’. Obligations through the contract are at least $9.4 billion. The new system has been implemented to date in five VA medical centers out of 171. [TTA 18 Mar]

Updated. Another five-hour outage of both VA and DOD-MHS systems occurred on Monday 17 April. Affected systems included PowerChart, RevCycle, and other applications with latency issues and freezing. This may have been a result of transitioning to a larger database over the weekend. Today (Wednesday 19 April), the House Veterans’ Affairs Subcommittee on Oversight and Investigations will hold hearings on the proposals contained in the two House bills.  FedScoop

If Oracle really wants to transform healthcare, it can start with the VA as Job #1. Or give the keys to Epic. The VA is between the proverbial rock and a hard place. VA has to end VistA even though the old system is still being upgraded during the transition. Terminating the deal with Oracle and reverting five health systems would be perilous, if even possible. But the stakes for Oracle are even higher. Let’s start with billions in Federal contracts in other parts of government systems outside of healthcare. To get into healthcare EHRs, Oracle bought a Pandora’s Box with Cerner. The stakes are not only for our veterans but also to salvage its credibility in healthcare versus Epic–and with its lenders who financed the heavily leveraged Cerner acquisition plus $90 billion in debt load [TTA 10 Nov 22]. 

Lightning news roundup: AI for health systems Olive scores $400M, VA’s sticking with Cerner EHR, Black+Decker gets into the PERS game

July 2, 2021 | by

As here in the US we are winding up for our Independence Day holiday (apologies to King George III)….

Olive, a healthcare automation company for healthcare organizations, scored a venture round of $400 million from Vista Equity Partners. To date, it’s raised $856 million through a Series G plus this round and is now valued at $4 billion according to the company release. Olive’s value proposition is automating via AI routine processes and workflows, such as benefit verification discovery, prior authorizations, and billing/payments for health systems. About 900 US hospitals have adopted Olive’s systems. Mobihealthnews.

Breaking: The US Department of Veterans Affairs will be staying with Cerner Millenium for their EHR modernization from VistA. This follows a 12-week review of the implementation following failures within the $16 billion program itemized by the Government Accountability Office (GAO) in February [TTA 19 Feb]. Secretary Denis McDonough is scheduling two further review weeks to determine additional changes to the program. The intent is to build a cloud-based system fully interoperable with the Department of Defense’s Military Health System (MHS) also built with Cerner. FedScoop, Healthcare IT News

And in the What Are They Drinking in Marketing? I want some of that, stat! department…

Black + Decker is now becoming a PERS provider with the introduction of Black+Decker Health and the goVia line of mobile and home-based PERS with optional fall extension and call center monitoring through Medical Guardian . The devices are a fairly predictable line of cellular-connected (Verizon, AT+T) with a ‘classic’ home landline unit. The units are being sold through Amazon. B+D release

From a marketing perspective, the Black+Decker name, identified for decades with home and power tools, on a PERS line is also a classic–a classic mistaken line extension like Cadbury mashed potatoes or Colgate frozen entrees. Buy a PERS, get a drill? Relevance and fit to a older, female-skewing group?  It surely looks like their parent Stanley, which is a leading company in institutional alarm and location services. offloaded this legacy business to them. (Judging from the website, someone’s in a rush as some pages still have ‘greek’ copy under headings.) Hat tip to a Reader who wishes to remain anonymous.

GAO tells VA to postpone Cerner EHR implementation–but VA will be continuing

February 19, 2021 | by

The US Department of Veterans Affairs (VA) is still in the long rollout of the Cerner/Leidos EHR system to replace their home-grown, once groundbreaking VistA and to be interoperable with the Department of Defense’s Cerner Millenium system. The Government Accountability Office (GAO) issued a report (PDF link) that concludes that “VA should postpone deployment of its new EHR system at planned locations until any resulting critical and high severity test findings are appropriately addressed.” These potential system failure points were brought up by GAO to Congress last October at the time of the first implementation in Spokane, Washington. The sidebar on GAO’s report states that VA agreed with the postponement, but a news report in FedScoop indicates that VA believes, per their comments in the report, that:

  • VA and Cerner have resolved the major issues (down to 55 from close to 400)
  • They will resolve the rest by January 2022
  • They will proceed with the scheduled rollout to the VA’s Puget Sound Health Care System in Q4 2021.

Hat tip to HISTalk, which managed to summarize this in seven short sentences (!).

VA’s ‘Anywhere to Anywhere’ telehealth initiative finalizes

May 24, 2018 | by

VA Secretaries may come and go (or never get there), but their initiatives stay. With much fanfare last year, then-Secretary David Shulkin announced the ‘Anywhere to Anywhere’ telehealth and telemedicine program [TTA 3 Aug]. This program will use VA practitioners to provide virtual patient care across state lines when a veteran cannot make it to a VA hospital or clinic. The Department of Veterans Affairs published the proposed rule last October [TTA 3 Oct 17] with the Final Rule published in the Federal Register on 11 May.

Technically, it preempts state and local regulations around telehealth. “VA is exercising Federal preemption of conflicting State laws relating to the practice of healthcare providers; laws, rules, regulations, or other requirements are preempted to the extent such State laws conflict with the ability of VA health care providers to engage in the practice of telehealth while acting within the scope of their VA employment.”

It was widely supported by ATA, the American Association of Family Physicians, American Medical Informatics Association, Federal Trade Commission, the College of Healthcare Information Management Executives (CHIME), and many other industry organizations. It also enjoys wide Congressional support.

There is plenty of room for growth. Only 1 percent of VA’s veterans used Home Telehealth, while 12 percent used other forms of telehealth. They will be doing so with few suppliers: Medtronic, 1Vision/AMC Health, and Care Innovations. Iron Bow/Vivify Health was found to not have tablets which met the US production qualification. This Editor wonders how the current three suppliers will fare.

This telehealth program will be located in the apparently newly named Veterans Health Administration Office of Connected Care. mHealthIntelligence.com

VA awards over $1 billion in Home Telehealth contracts–at long last (updated)

February 6, 2017 | by | 15 Comments

Breaking News, Updated  The Department of Veterans Affairs (VA) on 1 Feb issued over $1 billion in awards to four companies to provide Home Telehealth vital signs monitoring technologies to veterans in home care and monitoring. The four companies are Medtronic, Care Innovations, Iron Bow Technologies, and 1Vision LLC. The $1 billion is split evenly between the four ($258 million for each company over the five-year duration). The contracts are for an initial year (31 Jan 2018 end date listed on GovTribe.com), renewable annually for five years total. The bid process started in 2015 and the award had originally been scheduled for early-to-mid 2016.

On the suppliers:

  • Medtronic is the incumbent as a supplier since 2011, dating back to Cardiocom’s 2011 award for its home monitoring units (Cardiocom was acquired in August 2013). Medtronic is a Dublin, Ireland HQ’d company with a US headquarters in Minnesota.
  • Care Innovations is well known to our Readers as the developer of Health Harmony and the acquirer of the QuietCare telecare/behavioral monitoring used in senior housing. Their parent is Intel.
  • Iron Bow Technologies is a supplier to VA in other healthcare areas (telemedicine and store-and-forward) and is a large, privately held IT company with multiple Federal contracts and deep Federal contractor roots. Their revenue has been reported at over $462 million (Washington Technology Top 100 2016).
  • 1Vision LLC is a new company formed as a joint venture between HMS Technologies, Inc. and MBL Technologies, Inc. Neither are previously engaged as home telehealth providers, but both are Federal contractors. According to their individual websites, HMS is an IT systems integrator and MBL is engaged primarily in cybersecurity.

The question for this Editor is how Iron Bow and 1Vision, which are not telehealth (vital signs) monitoring companies but telemedicine and IT service providers respectively, will execute Home Telehealth with the VA. Have they partnered with yet-to-be disclosed providers in providing home telehealth services to the VA? (Watch this space)

While the award is the largest in US telehealth, the VA is, by this Editor’s experience in her last position with Viterion Corporation, extremely demanding on its service providers and will be even more so in the future. The future reasons are clear: 1) President Trump has put a Klieg light on the VA and 2) he’s named a new VA secretary, Dr David Shulkin, who is currently VA Undersecretary for Health (confirmation hearing notes courtesy of POLITICO, nomination approved by the Senate committee Tuesday, and easily confirmed Monday night 13 Feb), who has been highly engaged with HIT issues, including both the VistA EHR modernization/replacement and initiatives such as the recently unveiled Digital Health Platform [TTA 12 Jan]. (more…)

Senate Veterans Affairs Committee takes evidence on VETS Act (US)

November 21, 2015 | by

Further to our report in October on the introduction of the Veterans E-Health & Telemedicine [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/Dept-of-VA-logo.jpg” thumb_width=”150″ /]Support Act (“Veterans eHealth & Telemedicine”, 10 October 2015), Sen. Joni Ernst’s website reports that Sen. Ernst was the first witness to testify in front of the Senate Veterans Affairs Committee on Wednesday (19 November 2015) about the proposed legislation.

“The VA has been practicing telemedicine since 2001, and they are largely cited as leaders and innovators in the field. Their efforts in telemedicine have saved money and veterans’ time by eliminating often an hour or more long drives to the VA, and reducing bed days at the VA” Ernst is reported to have said.

“For example: According to the VA, in Fiscal Year 2014, telehealth reduced bed days of care by 54%, reduced hospital admissions by 32%, and saved $34 in travel savings per  consultation. (more…)

Tunstall adds services for Australian veterans, upgrades US call centers

May 29, 2015 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Tunstall has been quiet on the newsfront lately, so these two items from Australia and the US are to be noted. In Australia, the Department of Veterans Affairs (DVA) rehabilitation appliances program (RAP), which provides subsidized personal response systems to veterans, now includes Tunstall’s PERS, iVi fall detector pendant, PIR movement sensor and GPS watch. The program requires that veterans be evaluated for need by a qualified health provider. Tunstall has participated in the RAP program since 2002. Pulse+IT (Australasia) In the US, a significant part of Tunstall’s purchase of AMAC were medical answering service operations in Long Island City, NY, Pawtucket, RI, and Newington, CT. A $10 million upgrade of their 24/7 service includes CRM for healthcare providers for after-hours, overflow support, appointment reminders, insurance verification and help desk services. Release

12 percent of US veterans now using VA telehealth services

October 15, 2014 | by

The US Department of Veterans Affairs (VA) has some good news (for a change)–that during the just-closed Federal FY 2014, 690,000 veterans, or 12 percent, used telehealth services. This was a 13.3 percent increase over FY 2013 (608,900). While this report is preliminary (beware!), we see a slowing of growth in the number of veterans accessing telehealth and a concentration–not dispersal–of telehealth services in rural areas (+ 10 points). This chart compares the numbers:

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/10/VA-2014-vs-2013.jpg” thumb_width=”350″ /]

Chart: EIC Donna. Please note that percentage of telehealth users add up to over 100 percent due to usage (one patient could access two or three forms of telehealth. FY14 telehealth user breakout is estimate based on FY13 percentage, to be eventually compared to official figures.)

Telehealth as defined by VA: (more…)

The King’s Fund videos, presentations online

October 4, 2014 | by

The King’s Fund has posted video highlights from last month’s International Digital Health and Care Congress. Talks include those from futurist Ray Hammond, Kathleen Hammond (US Department of Veterans Affairs), Dr Ali Parsa (Babylon), Paul Rice (NHS England) and Sian Jones (NHS Bristol). Click on the tabs at top for presentation decks and posters. TTA was a media partner of the Congress. Hat tip to Mike Clark via Twitter (@clarkmike).