NHS electronic patient records linked to 100 ‘serious harm’ issues, with ~50% of NHS England trusts reporting patient issues: BBC News

June 4, 2024 | by

EHR harm is not exclusive to the VA, or the US. An investigation published last week by BBC News uncovered problems with IT systems used by NHS England regional trusts to manage patient records. Through a Freedom of Information (FOI) request, it uncovered multiple problems with Electronic Patient Record (EPR) systems that could affect patient care or lead to potential harm. Their investigation found that “IT system failures have been linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital trusts in England.”

The NHS has spent £900 million over the past two years in pushing trusts to procure EPR systems and to go entirely paperless. The original deadline of end of 2024 has long since been modified to 2026.

Currently, each trust manages its own IT adoption. Teaching hospitals are at the top with the best IT, whether EPRs or operational and clinical systems. Acute care hospitals come next with current systems and infrastructure. The trusts also commission and pay for community and mental health organizations plus general practitioners. They tend to be at the end of the technology chain, without data centers but maybe a computer room. There are lots of variations between trusts, plenty of custom systems, and paper. And as in the US, systems were not necessarily interoperable. (Background courtesy of Rackspace)

The NHS published last November that 90%, or 189, trusts had contracted for and adopted EPRs. EPRs adopted by the trusts include Oracle Cerner, Epic, Meditech, and Dedalus Orbis (replacing the ancient Lorenzo).

What the BBC found through the FOI:

  • 89 trusts confirmed they monitored and logged instances when patients could be harmed as a result of problems with their Electronic Patient Record (EPR) systems. Almost half recorded instances of potential patient harm linked to their systems.
  • Nearly 60 trusts reported IT problems that could affect patient care.
  • There were 126 instances of serious harm linked to IT issues across 31 trusts
  • There were three deaths across two trusts related to EPR problems
  • At the County Durham and Darlington NHS Foundation Trust, more than 2,000 incidents of potential patient harm and three other serious incidents were connected to their new Cerner EPR

Additionally, hundreds of thousands of medical letters went unsent to patients. From the FOI, 200,000 letters were not sent across 21 trusts. Last September, a separate BBC investigation found that 24,000 letters from Newcastle hospitals had not been sent from their EPR system, with more than 400,000 letters lost in computer systems at hospitals in Nottingham.

Separate from the FOI, the BBC report goes into two of the deaths relating to EPR lost information.

  • At Sheffield Teaching Hospitals Trust, a sickle cell anemia and cerebral palsy patient, Darnell Smith, aged 22, was admitted to the Royal Hallamshire Hospital with cold like symptoms in November 2022. His personal care plan was not easily visible in the hospital’s computerized records. He didn’t get the hourly checks he needed for heart rate, blood pressure and temperature. After the records were found, Mr. Smith was then moved to critical care, put on a ventilator the next morning, and died from pneumonia two weeks later. The coroner in this case warned of a “real risk of further deaths” if care teams couldn’t access needed medical information.
  • At University Hospital of North Durham, Emily Harkleroad collapsed and was taken to A&E, where a pulmonary embolism was diagnosed. However, due to errors in the newly installed Cerner EPR, she didn’t receive the blood thinners she needed and died the morning after admission. The coroner found that the EPR did not clearly identify which patients were the most critically ill and needed to be prioritized, a complaint that clinicians at the hospital had previously expressed.  

Clinicians who came forward to the BBC pointed to EPRs making critical information difficult or impossible to find–it could be “buried anywhere”, creating medication errors, and “incorrect patient details on theatre (sic) lists, incorrect operations listed, incorrect allergy status”. 

Professor Joe McDonald, a former NHS clinical leader, dubbed the current rollout of EPRs across trusts “a broken jigsaw” because very few are interoperable. His conclusion: “There is undoubtedly a culture of cover-up in the NHS and nowhere is that stronger than in the health IT sector. It’s not safe. It’s really not safe.”

BBC News also included a response from Professor Erika Denton, national medical director for transformation at NHS England. She stated that EPRs represent an improvement over paper and patchwork systems and have been shown to improve safety and care for patients. “However, like any system, it’s essential that they are introduced and operated to high standards, and NHS England is working closely with trusts to review any concerns raised and provide additional support and guidance on the safe use of their systems where required.”  Also Daily Mail and Yahoo News Canada (reprint of the BBC News article if blocked).

Oracle’s Glueck kicks back hard at Business Insider’s ‘deadly gamble’ article, Epic’s Faulkner (now with additional audio commentary)

May 31, 2024 | by

Oracle is making great progress at the VA. And they want EHR interoperability. Epic doesn’t. Take that, Business Insider! And Judy Faulkner! Ken Glueck, an EVP at Oracle, authored an Oracle blog post (or at least one written under his name) that has generated much industry controversy. It first goes after Business Insider for daring to criticize the problems on the Oracle Cerner rollout that made it into five (count ’em, five) VA regional systems, calling it a ‘regurgitated story’. It calls the ‘deadly gamble’ headline ‘clickbait’, moves to patting itself on the back for the apparently non-problematic EHR rollout in about 3,900 locations in the DOD-Military Health System (partnering with Leidos), then swerves to stating the obvious in kicking around poor old, outdated VistA that meets very different needs and a massive population at the VA, and ends with a tap dance around the Oracle Cerner EHR problems at the VA citing all the progress that Oracle is making. It builds to a final slam fest, taking a minor quote in the article regarding why Oracle’s Larry Ellison preferred to buy Cerner–a ‘more relaxed approach to data privacy’–and expanding that to hard personal takedowns of Epic and its founder Judy Faulkner.  It then gets personal with BI, depicting the publication as “rooting against us” which he finds “invigorating”.

One can understand the craving for Oracle management to respond to BI. It’s a media outlet that apparently doesn’t have the most friendly relationship with Oracle. (But since when is that a feature of the Fourth Estate?) The article vividly takes Oracle to task, weaving together an accessible story out of dry facts and the many technical failures well documented by the VA, the OIG, and in Congressional hearings. It’s framed in the noble ambitions of Oracle’s founder Larry Ellison to transform healthcare which, in this Editor’s view, are treated sympathetically. The extremely well-read review last week of the BI article notes all, as well as the lack of contrast with the non-eventful DOD-Military Health System’s implementation and why it went largely according to plan, including the joint Lovell MHS/VA EHR. While this Editor tends to cast a gimlet eye at the clichéd mention of ‘transforming healthcare’, she still has some hope that progress in simplification, transparency, better-informed decisions, and truly intelligent assistance that enables human providers to heal their patients will be made in the next decade. And in that, she is on the side of Mr. Ellison as well as most founders and companies in health tech chronicled in TTA’s articles since 2005.

You have to give Mr. Glueck some credit for not holding back on how he really feels. Unfortunately, he was writing a corporate communication even if it was slotted in Oracle’s blog pages. He’s worked in corporate for decades and early in his career in government in the late Senator Joe Lieberman’s (D-CT) office. From the blunt view of a marketer, he should know better. Tone matters. And the frostier the tone, the better. If even a response is needed. Consider: is responding to this a smart move? What are the knock on effects?

In fact, it’s almost a textbook on how not to respond to negative press.

  • The headline sets up a straw man argument: Business Insider is not responsible for healthcare modernization, nor conceivably will ever be. It’s a cheap shot. 
  • The overly personal tone, written (one can guess) as he was seething about the BI article, undermines the response.
  • Nearly all of the same points could have been made in a concise, objective, fact-by-fact rebuttal that would be far more powerful in its restraint.
  • It meanders. It’s defensive. It’s easy to read into the Congressional Record or at the next hearing of the Veterans Affairs committee by a House member or Senator who’d like to see Oracle Cerner derailed at the VA. 
  • Where it truly goes off the rails is the personal invective directed at their competition. “…Epic’s CEO Judy Faulkner is the single biggest obstacle to EHR interoperability. She opposes interoperability because it threatens Epic’s franchise.” Mr. Glueck goes further in stating that Oracle enables provider collaboration across silos, while “Epic’s contracts expressly appropriate all patient EHR data as Epic’s own.” This is a fair criticism if true but maybe Epic’s hospital customers like it that way for their own reasons like security.

The blog comes across as barely restrained and defensive, especially versus Epic, the #1 EHR. When your EHR is losing ground to the competition, this is not a good look. It hands Epic another club to beat Oracle with. When your audience consists of professional hospital and practice executives, plus the VA and Congress, who right now aren’t overly happy with your EHR and are firing Oracle or considering it, this is almost guaranteed to backfire. It also gives a provocative article in a small online publication (ask Elon Musk) what Oracle doesn’t want–very long legs and a long shelf life. Plus now, there is even more reason for BI to beat up on Oracle.

Perhaps ignoring it, coupled with a sober internal communication (email/intranet/Slack) on the progress being made with the VA EHR (given that internal comms leak onto Reddit and similar), would have been the best response choices. And what about a conversation with BI? 

Like the old Sicilian saying about revenge, dishes like this should be served cold. 

Some interesting responses to the Oracle blog post are in HIStalk Reader Comments 5-31-24   Also Becker’s

And if anyone at Oracle wants a free tutorial in what not to do to respond to negative press, from the perspective of someone who’s had to deal with it in two industries….donna.cusano@telecareaware.com

Listen to Editor Donna provide extra commentary–a take on this take–on the Ken Glueck blog and this article. Now on Soundcloud (~18 minutes).

Must read: Oracle’s ‘deadly gamble’ on Cerner (new with audio file!)

May 22, 2024 | by | 3 Comments

Larry Ellison’s $28 billion bet on Cerner is drawn and quartered in this Must Read. If any further confirmation is needed that Cerner was the proverbial pig-in-poke for Ellison’s Big Vision of welding all that Cerner EHR data with Oracle’s massive technology, it is right here. Ashley Stewart and Blake Dodge, writing for Business Insider, do a masterful job of painting how badly Ellison and Oracle misjudged what they were getting into with what proved to be Cerner’s “broken and dysfunctional system” that in the VA implementation has been put on hold, with one exception, for a year or maybe more.

What Ellison thought he was buying in 2021 could be summarized by what he said at Oracle CloudWorld in fall 2023. FTA: What if, instead of guesswork, doctors could lean on generative AI to comb through a patient’s medical records, along with those of millions of other patients? With such a massive database, doctors could spot the warning signs of disease faster, reduce the need for trial and error, and make better-informed decisions about treatment. In other words, pump all that massive data into Oracle’s AI models and watch all that data, now going to waste, transform healthcare.

The problem was Cerner itself. Its EHR was not the wonder that Ellison saw circa 2005 when he first approached them and was rebuffed as a Silicon Valley interloper. It had become a system that wore lead boots compared to Epic. In the provider market, it was sinking to a distant #2. But one revelation in the article is that by 2020 Oracle saw Cerner as a must-have. As a smaller system, it was perceived as more interoperable between health systems, providers, and with third parties. Data would be more readily accessible. Pandemic-era relaxations on data sharing further loosened restrictions on access. The looseness appealed to Ellison and Company–and Cerner’s book of business would also help Oracle compete in cloud computing with Amazon (AWS) and Microsoft.

But Healthcare Reality dawned with the first implementations in the VA that started in 2020, a big win that turned into a rolling disaster that led to unknown queues, vanishing prescriptions, records, and appointments, and much more as chronicled here in the past four years, by Congressional investigations, and the VA’s OIG. No, the problems weren’t easily ‘fixable and addressable’ in Mike Sicilia’s (Oracle) words to Congress in hearings shortly after the acquisition closed. In fairly short order, the rollout came to a screeching halt after thousands of Oracle fixes, with only five systems implemented through last June, no end of disasters, patient deaths, and exacerbated illnesses. Other than the Lovell/MHS joint facility March rollout, there will be no further installations planned by the VA until the next fiscal year that starts in October. The most optimistic timeline for resumption is by end of this calendar year. As Congress is making clear, without proof of improved performance par with VistA in the current systems, do not hold your breath for any new ones.

An additional revelation in the article is that over time, VistA had become so customized to each VA medical center that Cerner could never meet those demands expected by the staff. It stopped trying, leading to more dissatisfaction. Perhaps that standardization looks good at the 40,000 foot level, but there were reasons for the customizations based on the veteran population and practice. Things that took two minutes in VistA now took ten in Cerner–if you were lucky. In the closed VistA system, those customizations were passed around other centers and regions–in VA-speak, Veterans Integrated Services Networks or VISNs. (Editor’s note: recalling from one of her former companies, any IT vendor implementing a system VISN by VISN soon learned about each one’s unique demands at multiple levels.)

“Oracle is still learning what they have actually acquired from Cerner,” according to an Oracle executive quoted in the article. The VA has become a ‘shackle’ trapping the Ellisonian Grand Vision of Oracle’s Transforming Healthcare–in time for him to enjoy his victory. Cerner’s slide to a distant #2 has reduced All That Data that made Cerner worth $28 billion, adding to a crushing debt load that this Editor and others noted in 2022. Layoffs and freezes haven’t made much difference, but have led to the loss of experienced Cerner support. The VA failures and drain of resources to fix it, the vacuum in support, and technical problems have led to, in a Providence system executive’s words, the perception that Cerner is ‘circling the drain’. And perception becomes reality. Health systems are choosing the costly route of moving now rather than later. The article mentions two major systems defecting to Epic, Intermountain and UPMC, but they are only two out of the 12 that announced in 2023. 

The narrative succeeds in bringing together many threads, but most of all in bringing to life the dry facts of Cerner’s many patient failures in the VA, including the individual deaths from the unknown queues [TTA 18 Mar 2023] and the human story of the Two Charlies–Charlie Bourg (himself affected by the unknown queue) and Charlie Monroe, both veterans near Spokane’s Mann-Grandstaff VA medical center. They advocate for veteran patients affected by the Cerner EHR’s many flaws.

One of the flaws not mentioned is Cerner’s odd lack of concentration on training criticized by Congress in 2023 [TTA 19 Apr 2023]. Another sequel or extension to this article could delve into the DOD-Military Health System’s implementation, a Leidos-Cerner project that has had few of the reported problems of Cerner Millenium in the VA. This was quoted by a former VA official as a ‘terrible decision’ that knocked onto the VA in implementing into a much larger and more complex healthcare system. Hat tip to HIStalk 5/22/24

Editor’s Closing Note: A wise doctor told me once that most errors in practice are made at the beginning and at the end of one’s career. In business, your Editor has seen this parallel happen time and time again. Even the smartest of chairmen and CEOs, when they stay too long at the fair, often make poor decisions. Is it age? Illness? No one left with the courage to tell them no, this is a bad move, this isn’t working? I think of the last years of Centene’s leader Michael Neidorff, 25 years in leadership, ousted by an activist shareholder. Mark Bertolini of Aetna, shoved aside from the merger with CVS he engineered. Frank Lorenzo, who created the biggest airline combine ever, Texas Air Corporation. Even legends like Larry Ellison at 79 may not be what they were. In attempting to capstone his storied career, and with the best of intentions in transforming the broken, dysfunctional healthcare system, has he made a gamble that could bring Oracle to its knees?

Listen (for the first time!) to Editor Donna read this article with extra asides and comments (plus a small flub or two). Now on Soundcloud.

Our view from last week: Is Oracle Health’s Big Vision smacking into the wall of Healthcare Reality? Their business says so. 

Is Oracle Health’s Big Vision smacking into the wall of Healthcare Reality? Their business says so.

May 15, 2024 | by

Once again, ‘healthcare transformation’ may be A Bridge Too Far but definitely a Long Slog for Oracle. A highly critical Bloomberg report details the flat and deteriorating business of Oracle Health, the division that includes the former Cerner. Since their much-touted acquisition of Cerner two years ago [TTA 14 June 2022], Oracle has not righted the basic health system EHR business. Revenue and clients have stagnated with high-profile losses, versus the massive gains predicted only two years ago, and Cerner falling further behind the hospital/practice EHR leader, Epic, with a 26% hospital bed share compared to Epic’s 48%. 

  • Bloomberg’s internal sources indicated that sales reached $5.9 billion in 2023, but are projected to slip to $5.6 billion both in 2024 and 2025.
  • In 2023, 12 accounts did not renew and announced they would replace Cerner with Epic. These are major names such as Northwell Health and Boston Children’s Hospital. In 2022, clients with a combined capacity of 4,658 patients were lost, according to KLAS Research. This is despite the fact that EHRs are not moved lightly. The average commitment is 15 years or more since the ramp-up is taxing and costs are astronomical.
  • Common complaints cited by KLAS center around Cerner’s legacy software and the Cerner transition: tracking clinical revenue, tool integration, technical glitches, and uncertainty or worsened service associated with the Oracle takeover.Boston moved to improve data exchange with surrounding hospitals and Northwell for Epic’s set of better integrated tools.

Oracle laid off many involved with customer accounts. The consulting and sales area laid off 3,000 in one year from March 2023 to February 2024, according to Bloomberg. These may have been as early as May 2023. In June 2023, there were reports that the VA’s pause of Cerner Millenium for at least a year coupled with the completion of MHS Genesis triggered 500 to 1,200 additional Federal service area layoffs plus rescinded job offers. The layoff total may be as high as 4,200 on a pre-acquisition employee base of 28,000, with salaries and promotions frozen. On the executive level, Don Johnson, who once was a successor to CEO Larry Ellison, departed from leading Oracle Health and AI. Reportedly, Dr. David Feinberg, who briefly headed Cerner prior to the sale, is now a ‘ceremonial’ chairman of Oracle Health. [TTA 18 May 2023] Dr. Feinberg also joined Aegis Ventures as a senior advisor and is on Humana’s board, which sounds like a winddown of Oracle responsibilities [TTA 11 Jan]. The layoffs and freezes have improved the former Cerner’s operating margin from 22% to 33%, but not as high as Oracle’s 46% margin.

Since the acquisition and chairman Larry Ellison’s Big Vision promises of creating ‘healthcare transformation’ and ‘better information’, Oracle’s challenge with Cerner has been not only to move their legacy systems onto the cloud but also to integrate Cerner systems with Oracle–and Oracle may have underestimated that complexity as well.

  • Oracle has stated that most customers have been moved to Oracle’s cloud, but inside sources have qualified them as Oracle Health’s smallest and least technically complicated. The big systems with their own domains have yet to be touched.
  • Cerner applications had about 8,000 bugs to be fixed.
  • On the people management/integration side, there are substantial differences between ‘legacy’ Cerner and Oracle people, often centering around not understanding the nuances and complexities inherent in healthcare–as well as compensation and working conditions. This Editor, who as a marketer has had to deal peripherally with ‘legacy systems’ (to the point of tears) through acquisitions on the payer side, knows this is common.

Where Oracle has had success with Cerner’s EHR is in international markets less saturated with EHRs or with home-grown systems, winning contracts in Sweden, the UK and Saudi Arabia. As previously noted, they are a supplier for the NHS. Oracle has moved forward on population health software,  modernizing Cerner’s revenue-tracking tool, and planning for an AI-assisted ambient listening voice note system. 

What remains up in the air is if the VA will restart Millenium transitioning from VistA this year. Oracle is pushing to restart it and its revenue stream this summer as projected last year [TTA 18 May 2023]. This counters VA Secretary Denis McDonough’s testimony last month to the House Veterans Affairs Committee that the VA does not intend to resume deploying it until FY 2025, which does not start until October 2024, and use carryover funding. This FY, there are no funds or plans allocated except for Lovell FHCC, which seems to be going well. The contract, already tightened last April with multiple metrics, demanded improvements, oversight, and annual renewals, is running into more Congressional headwinds this year. Three senators on the Senate Veterans’ Affairs Committee called for the VA “to use the opportunity the new contract structure provides to re-review terms and add additional accountability and oversight provisions to protect veterans and taxpayers.” pointing to the OIG report issued in March. The contract is up for renewal this coming Thursday 16 May. NextGov, Becker’s

The final burden on Oracle–only alluded to in the article–is the debt load undertaken to finance the $28 billion Cerner acquisition. A complex set of bridge and term loans were used to finance the buy [TTA 27 Oct 2022]. At the time, Oracle’s $90 billion debt load was one of the largest in tech. While Oracle’s stock value has been buoyed by its investments in AI, in the current environment, this debt load becomes suspect. Yahoo Finance, Quartz

Midweek news roundup: Optum exiting telehealth, laying off; Advocate Health selling MobileHelp; VA notifying 15M veterans re Change PHI breach, Oracle moving to Nashville–maybe? (updated)

May 1, 2024 | by

Optum Virtual Care closing, staff layoffs in progress. Optum Everycare CEO Jennifer Phalen on an 18 April internal conference call announced that the unit would close. According to sources, some employees would have layoff dates in July. No further details were available on other layoffs or plans for integrating Virtual Care’s capabilities into other Optum units, except for generalities. “We are com­mit­ted to pro­vid­ing pa­tients with a ro­bust net­work of providers for vir­tu­al ur­gent, pri­ma­ry and spe­cial­ty care op­tions,” and “We con­tin­u­al­ly re­view the ca­pa­bil­i­ties and ser­vices we of­fer to meet the grow­ing and evolv­ing needs of our busi­ness­es and the peo­ple we serve.” a spokesper­son for Unit­ed­Health said to End­points, a biopharma publication from the University of Kansas which broke the story.

For Optum, this is the second shoe drop about layoffs and closures in less than two weeks. Reports from social media and layoff-specific boards indicated that thousands were being laid off, from their plans to urgent care and providers [TTA 23 Apr]. These were not confirmed by Optum nor by UnitedHealth Group. It’s not known if this unit’s closure was included in the total. 

The larger picture is that it is symptomatic of the sudden growth, then equally sudden consolidation, of general telehealth. Optum opened the unit in April 2021 as the pandemic entered year 2. Utilizing existing capabilities, UHG claimed it facilitated more than 33 million telehealth visits in 2020, up from 1.2 million in 2019. The number looks sky high but in that time of practices closing it was a free-for-all in telehealth–and ‘facilitating’ is a nebulous catchword that could mean a practice using Facetime, telephones, or an EHR/population health platform module. Commercial claims for telehealth have remained at 4 to 5% since (FAIR Health, Jan 2024). Even during the pandemic’s first year, telehealth claims hit a peak of 13 percent in April 2020 that dropped fast to 6% by August 2020. Well over 60% are for behavioral telehealth claims.

A leading indicator: Last June, Optum Everycare’s CEO from their 2021 start, Kristi Henderson, a former Optum SVP for digital transformation, departed to become CEO of Confluent Health, a national network of occupational and physical therapy clinics. It was about as far away as one could get from telehealth, digital transformation, and Amazon Care, her former employer that expired in 2022.

Apparently, UHG and Optum see no further need for a virtual care specialty unit, instead integrating it into plans and other Optum services. According to MedCityNews, industry analysts aren’t surprised. Both Amwell and Teladoc have had well-known struggles. The latest: Walmart, after investing millions into their unit that included full clinics and a virtual care service, also made news on 30 April that it is closing both. Also greatly on UHG’s mind: cleanup after the Change debacle, making Mr. Market happy, and the looming antitrust action by DOJ. Becker’s, Healthcare IT News, 

In another sign that healthcare investors are selling off ancillary businesses, Advocate Health is selling PERS provider MobileHelp. It “no longer fit the strategic priorities of Advocate Health” according to their 22 April audit report (see document pages 10 and 13) and was authorized last December.

Advocate, through its investment arm Advocate Aurora Enterprises, acquired both MobileHelp, one of the earliest mobile PERS, and sister company Clear Arch Health, a remote patient monitoring provider, in April 2022. Cost was not disclosed at that time but later was reported to be $290.7 million. The plan at the time was to combine both MobileHelp and Clear Arch with a senior care/home health provider earlier acquired by Advocate for $187 million, Senior Helpers. That company was sold in March to Chicago-based private equity firm Waud Capital Partners for an undisclosed amount. The MobileHelp sale is expected to close later this year. Buyer and price are not disclosed. The expected loss on the MobileHelp sale was figured into FY 2023 as part of an asset impairment write-down of $150 million, which Advocate said was “related to the expected loss on the sale of MobileHelp.” The PERS and RPM business is a largely consolidated ‘cash cow’ type of business that (Editor’s prediction) will be snapped up by another player like Connect America, Alert One, or a smaller player like ModivCare. Milwaukee Business Journal, Becker’s, Crain’s Chicago Business (requires subscription)

VA admits that some veterans may be affected by Change Healthcare data breach, PII/PHI disclosure. While Department of Veterans Affairs Secretary Denis McDonough at this time believes that “there’s no confirmation yet” that veteran data was exposed, the scope of the Change Healthcare breach has led VA to formally alert via email 15 million veterans and their families of the possibility. The email also included information “about the two years of free credit monitoring and identity theft protection” that Change Healthcare is offering to those affected by the attack. The VA maintains that the attack resulted in only a temporary delay in filling 40,000 prescriptions but did not cause “any adverse impact on patient care or outcomes,” according to a department spokesman. NextGov/FCW 26 April, 23 April 

In related news, HHS as of 19 April had not received any notification from Change Healthcare nor UHG. They are required to file a breach report as providers and also as covered entities. They have 60 days from the breach occurrence on 21 February to report, which is coming right up. Becker’s

If Larry said it, it must be true…assemble the moving boxes. At an Oracle conference in Nashville last week, Oracle chairman Larry Ellison said to Bill Frist of investment firm Frist Cressey Ventures that he planned to move the company to that city as “It’s the center of the industry we’re most concerned about, which is the healthcare industry.” It’s their second public Larry and Billy meetup in the last few months, the last in November at the Frist Cressey Ventures Forum where Ellison had previously touted Nashville. Ellison is investing in and building a 70-acre, $1.35 billion campus on Nashville’s riverfront. Oracle is currently HQ’d in Austin, Texas having moved in 2020 from Redwood City, California but with extensive facilities remaining in the state. Texas and Tennessee have one thing in common–a superior business climate. Both are long on lifestyle, though Austin is not as temperate (read, hot) as Nashville. What Nashville has that Austin doesn’t is being a healthcare hub. At least in Ellison’s view, healthcare is where it’s at and so is Nashville. So as long as he’s running Oracle from his manse on Lanai, Oracle does what Larry says. Healthcare Dive, Healthcare IT News, The Tennessean

More fun facts about Larry Ellison and Nashville: David Ellison, his son, is founder of Skydance Media, a major Hollywood production company (Mission: Impossible and others) and negotiating a zillion-dollar merger with Paramount Pictures. David’s wife is a singer trying to make it in Music City and they have a home there. Kind of like the age-old trend of moving the HQ near where the CEO’s living. On moving the HQ to Nashville from Austin, this would affect perhaps 2,500 workers based there currently. Most of Oracle’s workers are dispersed and work remotely. 6,400 of former Cerner-ites are still in Missouri and 7,000 remain in California. Big hat tip to HIStalk—scroll down and see more about Larry and Billy’s talk, which also covered cybersecurity, the NHS (which uses Cerner), and automating hospitals and the hospital-payer interface.

News roundup: Apple Watch flagships cease sale due to Masimo ITC ruling (updated); Noom, WW enter GLP-1 telehealth business; Oracle sees health side up despite Cerner drag; Cigna has multiple bidders for MA business

December 21, 2023 | by

Apple Watch Series 9 and Ultra 2 going off sale in the US this week, upholding the ITC patent ruling favoring medical device developer Masimo. On 26 October, the International Trade Commission (ITC) ruled that Apple in the Series 6 and later violated Masimo’s patents on pulse oximetry (SpO2) sensors and software. [TTA 27 Oct] While this is awaiting presidential approval in the 60-day review period which ends on Christmas Day, Apple proactively restricted US sales of its flagship Series 9 and Ultra 2 watches which contain the blood oxygen sensors. (The SE model does not and continues to be available for direct sale.) According to 9to5Mac, online sales end on 3 pm Eastern Time on Thursday 21 December, while in-Apple Store sales stop after Christmas Eve. Of course, this won’t stop resales of existing stock through outlets like Amazon, Best Buy, and eBay. Under the ITC order, Apple cannot import either model after 25 December as the ITC issued a Limited Exclusion Order (LEO) plus a Cease and Desist Order (CDO). 

The ITC is rarely vetoed by the White House in patent actions. After that point, Apple is free to appeal in Federal District Court, which is highly likely and where the deepest pockets usually win. Also HIStalk 20 Dec and Strata-gee 21 Dec

There are other wrinkles with Masimo, though. Strata-gee.com earlier this month (13 Dec) timelines Masimo’s patent difficulties with the US Patent and Trademark Office’s Patent Trial and Appeal Board (PTAB) ruling against the very same patents, decisions upheld by the Federal Circuit Court. The PTAB also ruled against Masimo in the requested review of two Apple patents. Apple’s retaliation is to threaten lawsuits on Masimo’s new smartwatches. The icing on this messy cake is the November Delaware Chancery Court decision against Masimo, awarding $17.8 million in legal fees to activist investors/shareholders Politan Capital Management and Politan Capital NY LLC in a board fight that culminated in two seats to Politan directors.  One can sense that Apple is biding its time, though they could end all of this by negotiating a royalty to Masimo. Updated: see report on the stay effective 27 December here.

Noom and WW enter the weight loss drug-by-telehealth race. Ozempic and Wegovy, GLP-1 agonists, are increasingly popular in off-label use for obesity to produce weight loss, prescribed and managed by telehealth teams.

  • Noom, previously stressing behavioral change via app coaching direct-to-consumer, in October announced at HLTH Noom Med, a drug-focused program prescribing medications such as Saxenda (liraglutide), Wegovy (semaglutide), and the new Zepbound (tirzepatide), a dual GLP-1/G1P, all of which are injectable medications along with other GLP-1 medications such as Ozempic.
  • WW or WeightWatchers last week announced the WeightWatchers Clinic program. Via their recently acquired telehealth weight loss platform Sequence, it will offer weight loss meds and team management.  

They join Teladoc in developing weight loss programs, though Teladoc supports a physician-based care product for employers [TTA 21 April]. Both Noom and WW emphasize that member patients must qualify for the programs based on weight, BMI, and medical condition. Participants are educated through materials, coaching on behavioral management, managing appetite, and nutrition, especially in maintaining adequate protein as these medications not only induce weight loss, but also muscle loss (sarcopenia). One hopes that their teams are also knowledgeable on how these medications that slow down digestion to induce a feeling of fullness don’t mix well with surgical sedation, and that they issue cautions to patients before elective surgery. MedCityNews, FierceHealthcare, Forbes   

Noom has also replaced most of its top management since its new CEO joined in July. There’s a new CFO, chief technology officer (CTO), general counsel, two senior VPs (corporate development and partnerships, healthcare sales and services) a senior director of brand and communications, chief growth officer, chief product officer, and head of people. FierceHealthcare

Oracle Q2 results miss forecasts in rebuilding Cerner. Oracle Health, including the former Cerner, and slowing cloud growth were the culprits in their fiscal Q2 2024. Total revenue was $12.9 billion, up 5% in US dollars (4% in constant currency). Analysts expected $13.05 billion. Excluding Cerner, growth would have been 6% though Oracle did not separately break out revenue for the Cerner EHR business. Investors have noted two consecutive quarters of off-track growth and a weaker forecast for the remainder of the year. According to CEO Safra Catz and chairman Larry Ellison on the earning call, many upgrades and “modernizations” are being made to Cerner Millenium that will wrap up this FY. Half of Millenium customers will be moving over to Oracle Cloud Infrastructure (OCI) by February. They are also “rewriting” Cerner’s health and data intelligence platform, Cerner HealtheIntent, to get into population-scaled health management. ‘Transforming healthcare’ is an expensive proposition indeed. No word on the VA.  FierceHealthcare, Oracle release

And a quick follow up on Cigna’s sale of their Medicare Advantage business. Two payers so far–Health Care Service Corp. (HCSC) and Elevance–are reported to be bidding for Cigna’s MA business. The value of the business is estimated to be about $3 billion and with just under 600,000 members as of September. Both HCSC and Elevance are much larger players in MA. HCSC has over 1 million MA members in Blue Cross Blue Shield affiliates in Illinois, Texas, New Mexico, Oklahoma, and Montana. Elevance, the former Anthem, has over 2 million MA members. Bidding is expected to close this week. While MA is losing money for Cigna, they could refuse to sell if bids are unsatisfactory. FierceHealthcare, Becker’s

News roundup: AstraZeneca’s Evinova to market clinical trial health tech; BehaVR-Fern merge; UpHealth sells Cloudbreak telehealth translation; MedwebX launches; Tunstall-UEdinburgh research partnership; NextGen loses 84 after going private

November 21, 2023 | by

AstraZeneca makes a bet on selling health tech for drug development. Evinova, a separate health tech business within AstraZeneca, will market and develop proprietary technology and sell it to other pharma, biotech, and clinical research organizations (CROs) to optimize clinical trials. According to their release, these technologies have already been used in successful clinical trials in over 40 countries. CROs Parexel and Fortrea have already formally agreed to offer the three-part Evinova ‘drug development suite’ to their customers. Other partnerships include Accenture and Amazon Web Services.

On the buy and funding side:

RealizedCare formed from BehaVR and Fern Health. This interesting combination of virtual reality behavioral health (BehaVR) and chronic pain manager Fern Health promises digital therapeutics for value-based chronic pain care management. RealizedCare’s market is health plans, employers and value-based providers, working with them to identify, assess, and engage their members, employees, and patients with chronic pain. Their advanced care management platform is powered by DTx technology to scale pain management. Fern Health is backed by Aachen, Germany pharmaceutical company Grünenthal which will be a strategic investor in RealizedCare.  The combined company will be US-based in Nashville. Financials and workforce transitions are not disclosed, but two CEOs are listed on their website–Brad Lawson, CEO, Fern Health, and Aaron Gani, founder and CEO. Release, Mobihealthnews

UpHealth sells off telehealth translation services holding Cloudbreak Health to private equity firm GTCR, as part of a complex reorganization. Cloudbreak provides video remote interpreting (VRI) through its Martti (My Accessible Real-Time Trusted Interpreter) tool to aid in simultaneous translation in over 250 languages. Purchase price is $180 million and subject to regulatory and shareholder approvals, with closing anticipated by Q1 2024. Cloudbreak is currently headquartered in Columbus, Ohio. UpHealth has been selling off and putting into Chapter 11 various holdings such as UpHealth Holdings [TTA 29 Sep], Behavioral Health Services (BHS), and Thrasys, Inc., but not the publicly traded UpHealth Inc., which closed today on the NYSE at $0.79 having just resumed trading (Yahoo Finance, UpHealth release). Reportedly UpHealth will be refocusing on addiction treatment services provided in South Florida. More on their complex financials in their Q3 report.  Release

Short takes:

Digital medical imaging and storage company Medweb announced MedwebX, a HIPAA-compliant solution designed for sharing imaging, studies, data, and reports across networks. Release

Oracle’s moves into Music City Nashville [TTA 2 Nov] continue with the announcement of the Oracle Health Summit on 13 February 2024. According to the Nashville Business Journal, it’s a brief one emailed out to save the date and confirm their information when further details are available. The invitation reads in part, “At this daylong event, you’ll network with peers, hear from experts on the latest trends, and learn how leading organizations are using data-driven technology to deliver human-centered experiences.” Wonder if Bill Frist will be invited.

Tunstall Healthcare and the University of Edinburgh signed a Memorandum of Understanding (MOU) on telecare research. Edinburgh’s Advanced Care Research Centre will provide the academic ecosystem for the partnership, including medicine, engineering, informatics, data, and social sciences. Research will center on the development and deployment of digital tools and techniques for telecare, including multi-partner collaborations.  AT Today

And just in time for Thanksgiving…post-going private NextGen Healthcare will be releasing 84 employees at its St. Louis, Missouri location, according to their WARN notice filed with the state. The layoffs are “as a result of staffing optimization efforts” in connection with the company’s purchase by private equity firm Thoma Bravo. Layoffs of management, supervisors, account receivables staff, representatives, and analysts who work onsite, hybrid, and remote will be staggered with some released 16 January with others 1 February and 1 March. Some employees will be remaining in St. Louis, though NextGen is headquartered in Atlanta. Becker’s, St. Louis Post-Dispatch, St. Louis Business Journal

This ‘n’ that: HHS settles *2017* ransomware breach, Carbon Health lays off 114 in restructuring, why oh why VC General Catalyst wants a $3B health system, when Larry Met Billy, a lexicon of workplace terms

November 2, 2023 | by

It only took five years to levy a $100,000 fine. Doctors’ Management Services, a Massachusetts-based medical management company, had a ransomware attack back in 2017 that exposed 206,695 individuals to personal health information violations. The Health and Human Services (HHS) Office for Civil Rights (OCR), which is charged with actually enforcing penalties and remedies for data breaches, decided that Doctors’ management hadn’t done quite enough to protect their patients. The cyberattack was identified in December 2018, but Doctors’ didn’t report the breach to OCR until April 2019. Their network had been infected with GandCrab ransomware. After determining various protection failures, HHS put them on a three-year corrective plan to protect their data and collected the $100,000 fine, their very first. But still, nearly four years later? And with breaches, ransomware, and hacking going on every day?  Healthcare Dive

Another Covid unicorn comes down with a bang. Carbon Health, a 13-state network of primary care clinics along with virtual care in areas such as mental health, says ‘bye’ to 114 or 5% of its staff. It grew and got funded big during Covid as it set up testing and vaccine initiatives, achieving a valuation of $3 billion. In 2021, Covid accounted for 60% of their revenue, but as it waned in 2022, so did their revenue by 23%. To date, their funding has been over $622 million, with $100 million in January in a Series D funded by CVS Health Ventures. This isn’t their first big layoff–200 staffers said goodbye in January as well as 250 in mid-2022 which was about 8%. Becker’s

General Catalyst’s newest venture into Health Transformation Land, HATco, The Health Assurance Transformation Corporation, is in the market for a health system in the “$1 billion to $3 billion” range. Not too small to not have an impact in their communities, and large enough to have capabilities around value-based care plus a track record of excellence. This is to create their ‘blueprint’ for healthcare transformation. Interested parties should contact CEO Marc Harrison, MD. Their other plans to get there were announced at HLTH. As to why…General Catalyst has had a lot of experience with companies, and perhaps they feel they have a Better Way to Get There. Becker’s, TTA 10 Oct.

Of Note…The second wealthiest executive in healthcare, Oracle’s Larry Ellison, wasn’t too busy to hang out with the third wealthiest on Forbes’ list, former senator and HCA honcho Bill Frist, in Nashville at the inaugural Frist Cressey Ventures Forum. Ellison is also investing in a 70-acre, $1.35 billion campus on Nashville’s riverfront. It’s always nice to make nice with the neighbors, especially when they have major holdings in a large health corporation. Becker’s

To wrap up This ‘N’ That, Becker’s has a useful article that will keep you au courant on those workplace terms you see on places like LinkedIn. ‘Quiet quitting’, so popular in 2021-2, has had its day with layoffs leading to real ‘quitting’, leaving behind ‘grumpy stayers’ who try to get away with ‘Bare Minimum Mondays’. ‘Coffee badging’ was a new one on your Editor. The rest are catchy phrases for things as old as time in the workplace.

Weekend recap from HIMSS23: Glen Tullman’s 5 predictions, HIStalk’s random four-day walk, Oracle Cerner integration ‘going great’, Seema Verma to Oracle, Caregility’s debuts three enhancements

April 22, 2023 | by

From the reports on HIMSS23, it seemed almost–normal. Companies were there, attendance was back to near pre-pandemic levels, a normal exhibit hall, and while it was Chicago complete with snow flurries, and there were differences–no aisle carpet in the exhibit hall ‘for the environment’, suits were a rarity, Cerner disappeared into Oracle Health, and the industry was through a cycle of boom then bust–it was almost Old Times. 

So what’s next? Filling that hunger for a future view was Glen Tullman, late of Allscripts and Livongo, now 7wireVentures founder and CEO of Transcarent. His five predictions were:

  1. Consumers are in charge. They have an array of options unless in an emergency. The industry must build a new and different relationship with them
  2. AI will inform the experience. Eliminate paperwork, simplify documentation, analytics to optimize staffing levels, improve use of real-time data in care.
  3. Care will happen in 60 seconds. Quick and convenient response to care has to be the norm, especially for chronic conditions. Without this, three undesirables will happen: avoidance of care, wait until their condition is so serious that their healthcare costs become much higher, or wind up in the emergency department.
  4. Health systems will be the hub…maybe. They can own the consumer health experience. But health systems will need to change their payment model. 
  5. At risk is no risk. Health systems must “lead the way” to value-based care, care quality, and what appropriate care plans should look like.

Interestingly, payers aren’t mentioned in this model–and they see themselves as the hub, not health systems, through their acquisitions are providers and home health. MedCityNews. 

HIStalk’s random HIMSS23 walk. Perhaps the best ‘you are there’ take on HIMSS23 was published over four days by HIStalk, including Dr. Jayne’s commentary. They need no commentary from your Editor, including surviving Chicago’s weather, the distances, the no-aisle carpet exhibit hall, long lines for coffee, and local dining delights including wet beef and tavern pizza (avoid deep dish). Pro tips: if you’re an exhibitor, book meetings in advance to assure your ROI, and nothing beats F2F–true of both HIMSS and ViVE, booths were packed.  They were there so you and I didn’t have to be. Where do you think HIMSS24 will be?

Monday: Mr. HIStalk, Dr. Jayne

Tuesday: Mr. HIStalk, Dr. Jayne

Wednesday: Mr. HIStalk, Dr. Jayne

Thursday: Mr. HIStalk, Dr. Jayne  (see in Mr. H’s comments about how Microsoft has quietly taken the lead in health tech with Azure, Nuance, and now generative AI. Watch out Larry Ellison.) 

Healthcare Dive interviewed David Feinberg, now chairman of Oracle Health. According to him, everything is going great with the Cerner integration. “The integration has been pretty smooth” and they are well on their way to creating “a cloud-enabled health platform that brings all kinds of information together to make individuals and communities healthier around the world” and in building an EHR-agnostic health records database to link thousands of separate hospital databases. No mention of the troubled VA EHR implementation. (Ahem)

Announced during HIMSS as an exclusive to Healthcare Dive, Seema Verma, formerly Centers for Medicare and Medicaid Services (CMS) administrator during the Trump administration, is joining Oracle Life Sciences, the company’s clinical trials business, as senior VP and general manager. She has spent the last two years as senior adviser to private equity firms TPG and Cressey, and serving on the board of directors for health tech companies Lumeris, Monogram, Wellsky, and Lifestance.

And to this Editor, Caregility, a cloud-based virtual care and telehealth platform that connects virtual visits, clinical consultations, tele-ICU, remote patient monitoring, and point-of-care observation in hospitals, announced that they have a new portfolio of AI-enhanced hybrid care solutions built on best-in-KLAS (non-EMR) Caregility Cloud. According to the release, “A computer vision application analyzes live video streams of patients and their environment to detect movement and changes that could lead to adverse events such as falls or self-harm. A contactless monitoring system continuously captures patient vital signs, detecting variations in heart rate, breathing patterns, and movement that could be indicative of physiological events like awakening from sleep or an induced coma. An ambient clinical intelligence algorithm generates documentation from live clinician and patient conversations for the patient’s electronic health record.”

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]. 

Week-end roundup: more House actions on telehealth benefits, VA EHR; Oracle exec moves to FDA digital health; Angle Health raises $58M; layoffs at Akili, Innovaccer, Athenahealth, Mindstrong

February 4, 2023 | by

Has the House in this 118th Congress acquired a propensity for taking fast action? It seems that under the new Speaker, the House on both sides, though divided, is energized and responding to changes that would benefit worker health–and perhaps find a way out of the VA Tower of Trouble that would ultimately benefit veteran care.

The first is a short (four page) bipartisan bill still in draft, the Telehealth Benefit Expansion for Workers Act, that would amend current law in the Public Health Service Act, the Employee Retirement Income and Security Act of 1974, and the Internal Revenue Code of 1986 to allow employers to provide telehealth to employees as excepted benefits. This allows employers to finance an additional benefit not covered under their primary health plan. Examples of excepted benefits are vision and dental plans. Sponsors of the bill are Rep. Suzan DelBene (D-WA) as lead and co-sponsors  Tim Walberg (D-MI), Angie Craig (D-MN), Ron Estes (R-KS), Mikie Sherrill (D-NJ), and Rick Allen (R-GA). This builds upon the Medicare and other plan reimbursement expansions contained in the omnibus budget plan passed in the 117th Congress that extended telehealth in high-deductible health plans with health savings accounts (HSAs). At this point, the bill is not numbered, submitted, or on Congress.gov. HealthcareITNews

Not addressed in this bill or any other is whether the extensions will cover hospital-at-home remote patient monitoring (RPM) that was permitted under waivers during the Public Health Emergency (PHE). With its scheduled 11 May end, the Connected Health Initiative (CHI) believes that CMS will not allow remote monitoring to continue in hospital-at-home programs, under current reimbursement and devices. CHI had sent Congress at the end of January a list of their priorities and they’ve received a hearing, but no action has been taken yet. Healthcare Finance

The second is a House bill that would support solving the issues around the VA implementation of the Oracle Cerner EHR without returning to VistA. This is being proposed by Democrats on the House Veterans’ Affairs Committee. According to FedScoop, which broke the story, this is being worked on as an alternative to Rep. Matt Rosendale’s H.R. 608 which would pull the plug on Oracle Cerner and revert back to VistA [TTA 1 Feb]. Exactly how this bill would solve Oracle Health’s issues with Cerner Millenium and support VA in continuing that EHR implementation after June is not specified. FedScoop’s source told them that “the proposal may have a wider scope than prior attempts at legislative oversight and could involve a complete rethink of how other IT projects are conducted within the agency. This proposal is focused at a higher level than just one program.” The lack of specificity in this broad brush is not precisely reassuring, but a bipartisan ‘game on’ by both parties on Veterans Affairs, perhaps a ‘good cop/bad cop’ treatment, could be an effective ‘nowhere to hide’ approach with Oracle. Becker’s

Oracle’s loss, FDA’s gain. Troy Tazbaz, formerly Oracle’s senior VP heading up their cloud transformation efforts, joined FDA as Director of their Center of Digital Health Excellence. In that capacity, he will be in charge of technology evaluation, policy development and strategic partnerships for safe healthcare use of digital technologies that advance public health. Certainly he is tanned, rested, and ready: Mr. Tazbaz  left Oracle last September and used part of that time to achieve a dream of bicycling from Chesapeake Bay in Maryland to San Francisco Bay over 58 days. FierceHealthcare

Employer insurer Angle Health raised a $58 million Series A. Lead was Portage Ventures, along with PruVen Capital, Wing Venture Capital, SixThirty Ventures, Mighty Capital, and several others. Angle’s angle is to act as a fully digital, full-stack insurance carrier that delivers comprehensive healthcare benefits tailored to startups and technology companies on one platform. Their baseline telehealth offering covers primary care, urgent care and behavioral health, outsourced to Included Health. They bundle this with administrative services and care navigation, and use the First Health and Cigna PPO networks according to their website. Angle recently expanded from Utah into Arizona, Georgia, Indiana, Ohio, Missouri, and South Carolina. Release, FierceHealthcare

Unfortunately, layoffs continue in and out of healthcare as funding and usage go south:

  • Akili Interactive in January cut 30% of staff, or 46 people. Akili has developed cognitive therapies for ADHD and other mental illness, including EndeavorRx, a prescription treatment delivered through a video game. Non-ADHD therapies have been put on hold. They announced going public via a SPAC in January 2022 via a merger with Social Capital Suvretta Holdings Corp. I which closed last August at over $14, and are currently trading at $1.92. Mobihealthnews
  • Innovaccer, a health data analytics company, later in January laid off 15%, or 245 people, in the US and India, to concentrate on their ‘core portfolio’. This is their second layoff round;  90 people or 8% went in September. This was quite a turnaround to their sunny-side up 2021, where they raised Series D and E rounds totaling $255 million backed by Tiger Global, Whale Rock, Mubadala Group, and Microsoft M12, achieving a unicorn valuation over $3 billion.  Mobihealthnews, Inc42.com
  • Athenahealth yesterday released 178, or 3% of its staff, two months after going private. They pointed to overhiring, a sluggish recovery in doctor visits, and inflation. They plan to release or move to less expensive office space in their current cities of Watertown, MA and Austin, TX. Boston Globe
  • In yet another sign that virtual mental health’s boom is deflating sharply, Silicon Valley-based Mindstrong is essentially shutting down. Almost all of its C-suite including the CEO and CFO are gone plus an additional 128 jobs including therapists. It is closing its headquarters and is ceasing patient services as of 10 March, yet is still recruiting on its website. Employees are departing between 24 March and 15 April, when presumably the last one out the door will turn out the lights.  Mindstrong raised over $160 million since 2014 including a $100 million Series C in 2020. Behavioral Health Business

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

January 27, 2023 | by

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.

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

November 10, 2022 | by

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

November 2, 2022 | by

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

October 27, 2022 | by

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

September 20, 2022 | by

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