House appropriates $1.9B for Oracle Cerner VA EHR modernization, $5.2B for telehealth, plus other technologies; Oracle lays off more Cerner staff

House appropriations for the VA in FY 2024 were passed last week, including requirements for the VA/Oracle Cerner EHR Modernization program. The House allocated $1.9 billion in total for VA’s Oracle Cerner EHRM program. According to the report in FedScoop, the topline amount is broken down as follows: $1.2 billion for the Oracle Cerner-operated contract, $424 million for infrastructure readiness, and $253 million for program management. 

The budget is part of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill 2024 (full bill). The bill goes to the Senate after the summer recess. See pages 53 and 54 for the EHRM.

Key points:

  • This appropriation is the sole source of funding for the EHR modernization program. “No authority is provided for funds from other VA accounts to be transferred into this account nor for funds from this account to be transferred out to other accounts.”
  • Reaffirms “quarterly reporting of obligations, expenditures, and deployment schedule by facility and the Office of Deputy Secretary to administer the initiative”
  • There is also a 25% contingency upon the VA Secretary to report any outstanding issues impacting the stability and usability of the system, certifying and detailing any changes to the deployment timeline, certifying the status of outstanding issues, and whether
    the system is ready and optimized for further deployment at VA sites. 
  • ” The Government Accountability Office is directed to continue quarterly performance reviews of EHRM deployment and to report to the Committees each quarter.”

Reports will start within 30 days of the enactment of the appropriations bill looking back on “each new requirement and customized interface added in fiscal years 2022 and 2023, including the cost of each, reasons for inclusion, and whether they were outside of the scope of the contract within 30 days of enactment of this Act.” At 45 days, the bill requires a briefing on how the Department plans to set enterprise standards. The bill also confirms that no new deployments are scheduled for FY2024 and the 25% of funds set aside for FY2023 in deployment will not be released. Also EHR Intelligence

The bill also allocates $5.2 billion for telehealth and connected care (page 42). This covers services in home telehealth, home telehealth prosthetics, and clinic-based telehealth. The bill encourages expanding telehealth capacity to address backlogs for disability exams and healthcare appointments when appropriate. Our top story on 9 June was the award of Home Telehealth monitoring contracts to incumbent Medtronic and newcomers Cognosante, Valor Healthcare, and DrKumo.

Included in other budget lines are healthcare technologies (pages 33-34) such as bioelectronic medicine/AI, early detection diagostics, focused ultrasound therapy, medical image exchange, migraine prevention and treatment, and respiratory illness diagnostics using 4-dimensional images of lung function. 

Meanwhile, Oracle is laying off more Cerner employees. Your Editor is basing this on a Reddit 1 August thread that has no totals but indicates that employees were told yesterday (1 August), given two weeks notice to 15 August, and that the layoffs hit areas such as revenue cycle, 10% of CernerWorks, and properties. CernerWorks hosts, manages, and monitors client systems by providing data center hosting services for Cerner EHRs and other SaaS. Whether any of this affects the VA is to be determined, but their Federal service area had 500 to a rumored 1,200 layoffs in June. This was not much of a surprise with the near-completion of the DOD Military Health System EHR implementation and the holdup save one of the VA’s implementations (except the joint VA-MHS Lovell facility in Chicago). Our Readers have heard this here first.

VA awards four remote patient monitoring companies to share in $1B Home Telehealth contract (updated)

The Department of Veterans Affairs awarded on 1 May the latest contract for veteran Home Telehealth (HT) remote patient monitoring systems to four companies. They are perennial and incumbent vendor Medtronic Care Management Services, with HT newcomers Cognosante, Valor Healthcare, and DrKumo.

The duration of the Remote Patient Monitoring-HT contract is for a base period of two years and six (6) option periods. Each vendor can receive a minimum of $100,000 and maximum of $250,000,000 for a total value of all vendors in the contract of $1.032 billion, which is about the same as the previous award setup. It covers 72,000 patients with chronic care, acute care, health promotion/disease prevention, and non-institutional care (NIC) needs, and was awarded through the Office of Connected Care. This contract provisions for systems and hardware/software tools for the connected care of veterans at home. The solicitation originally came out in September 2021 and the award for multiple reasons was delayed for nearly two years.

Cognosante is perhaps the most interesting one here as an IT services company that offers telehealth and RPM as part of a main suite of diversified business process outsourcing. It already does business with the VA and the government, most recently with the VA in 2022 for support of a system used to manage referral and authorization processes for community care services (GovConWire). Former Senator Thomas Daschle is on their board of directors.

Valor Healthcare also is a current VA provider in operating more than 50 community-based outpatient clinics (CBOCs). Valor as prime contractor partnered with GlobalMed on the contract, with GlobalMed as the technology provider for software integration and security services. GlobalMed already provides telemedicine carts to the VA and is a contractor for virtual health services for the Defense Health Agency’s (DHA) Medical Community of Interest network.

DrKumo is the upstart, founded in 2021 by CEO Kelly Nguyen, Pharm.D and CTO Duc Pham. Their main feature is RPM for disease and chronic care management. 

All four companies prominently feature their connections with the VA and veterans, featuring the latter prominently in their management. Medtronic is the long-time (since the ’00s) incumbent and a leading vendor to the VA and the MHS in multiple areas.

The VA is a tough client, which other companies with HT contracts (and the personal experience of this Editor while marketing director of Viterion two contracts ago) can testify to. While VA may award contracts with four companies, many things can happen in the execution, such as failure to satisfy government US-origin requirements on the hardware origins, as specified in the Trade Agreements Act (TAA). Your hardware will need to be “substantially transformed” in the US or in a signatory country designated by the TAA. More than one vendor has effectively lost their contract over this; it happened to Vivify Health (now part of Optum) in 2018 and they with Iron Bow walked away [TTA 16 Jan 2018]. Another major hurdle is acceptance by VA care teams, and here all three companies are up against incumbent Medtronic.

Update 1 Nov: Another incumbent, AMC Health, which in 2022 partnered with GE HealthCare on post-hospital monitoring, switched partnerships and moved to partner with Cognosante. Partnerships are near-impossible to discern from the award notices. This is per their chief operating officer, James Considine, to the Editor. 

Becker’s, GovConWire, Valor release, GlobalMed release, SAM.gov award notice-Medtronic, SAM.gov award notice-Valor, SAM.gov award notice-DrKumo, SAM.gov award notice-Cognosante

Connecting JPM and CES dots: Babylon Health tripling revenue in ’22 to $1 billion–how? And Bosch tiptoes back into healthcare.

Dig for dots with your Editor….Babylon Health used their JPM forum last week to announce that with some US agreements signed, they expect by the end of this month to top $80 million per month, closing in on $1 billion this year, based on signing US value-based care agreements. The US agreements add an estimated 88,000 organic new members, bringing global managed lives to over 440,000. The $1 billion in revenue is nearly triple their 2021 preliminary closing revenue of $321 million. Interestingly, the US agreements were not specified in the release.

Does this tie in with the Higi acquisition [TTA 7 Jan], or are there others? Looking back on the Higi buy, we see one of the investors coming over from Higi is Glen Tullman, CEO of Transcarent and Managing Partner of VC 7wireVentures. His comments about Babylon in that release glow:

“Babylon’s innovative value and risk sharing models fit well with market leaders and innovators, including Transcarent, because they believe that, with the appropriate use of technology, data science, and good old-fashioned clinical care, you can impact the member satisfaction and quality of care, while, at the same time, reducing costs. This is the formula everyone has been searching for and the combination of Higi and Babylon bring us all one step closer.”

Higi is not large enough (though they claim ‘millions’) to boost Babylon’s revenues into the stratosphere, but some of Transcarent’s business very well might.

  • Transcarent earlier acquired BridgeHealth, a surgical and value-based benefits provider claiming 1 million members.
  • In October, Transcarent inked an agreement with Walmart to provide services for self-insured employers linking them to Walmart’s, including drug prescriptions.
  • Transcarent is on a funding roll of its own, with its own announcement at JPM in landing a $200 million Series C.

We’ll see if this Editor’s dots connect correctly….

Remember Bosch and health tech? Bosch was one of the ur-companies in remote patient monitoring with Health Hero/Health Buddy plus other telehealth/telecare businesses. Once upon an early 2010s time, they were a major supplier to VA Home Telehealth along with Viterion, Cardiocom, and Medtronic. After multiple setbacks, rounded up by TTA here, they exited European telehealth/telecare in January 2015 and shuttered Health Buddy six months later. So it’s déjà vu all over again to see Bosch technology used in a three-way project with Highmark Health in Pennsylvania and their Pediatric Institute of Allegheny Health Network (AHN) in Pittsburgh. AHN will be using Bosch’s SoundSee sensor-based tech to capture patient breathing audio that is then analyzed via Bosch’s proprietary AI and machine learning to detect pediatric pulmonary conditions. Clinical studies at AHN will be starting this quarter. Bosch’s Intelligent IoT group responsible for SoundSee is located at Bosch Research in Pittsburgh. Bosch has patented SoundSee for multiple applications in industrial and healthcare monitoring. Release, FierceHealthcare

Buried in the release is Bosch’s other step back into health tech. Vivatmo me, a breath-gas analyzer device that allows patients to accurately determine levels of inflammation, documenting them via an app–a very interesting concept–has been commercially available from March 2020 in Germany and Austria. It may be introduced in the US.

Rounding up the news: Babylon’s Samsung Health UK deal, smartphone urine test debuts, a VA Home Telehealth ‘announcement’, Aging 2.0’s NY Happy Hour

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”125″ /]Huge or Ho-Hum? Babylon’s ‘Ask an Expert’ feature is now available within the Samsung Health app as of the start of June. It will need to be activated at a cost of £50 per year, or £25 for a single consultation. Babylon’s service with over 200 GPs is now available on millions of Samsung Galaxy devices in the UK. Babylon now claims half a million users of its private GP services and 26,500 registered in London with its NHS-funded and controversial GP at Hand app.

Is it as our Editor Charles, quoting Niccolo Machiavelli writing in The Prince, “Nothing is more difficult to undertake, more perilous to conduct or more uncertain in its outcome than to take the lead in introducing a new order of things. For the innovator has for enemies all those who have done well under the old and lukewarm defenders who may do well under the new”. The debate rages–see the comments below the Pulse Today article. 

Healthy.io is introducing a test of its urinalysis by smartphone test with Salford Royal NHS Foundation Trust’s new Virtual Renal Clinic. 50 patients will received the Dip.io kit to test their urine. Dip.io uses the standard urine dipstick test combined with a smartphone application that guides the user through scanning in the results with a smartphone camera and sends the result to their doctor. Healthy.io claims this is a first-of-kind technology and system. According to Salford Royal, chronic kidney disease (CKD) costs the NHS £1.45 billion in England alone. The company is part of the NHS Innovation Accelerator Programme. Digital Health News

In what has been the worst kept secret in US telehealth, 1Vision LLC and AMC Health finally announced they were partners in 1Vision’s over $258 million Home Telehealth award by the Department of Veterans Affairs (VA) [TTA 6 Feb 17]. The news here is that the AMCH release states that they have an “Authority to Operate (ATO)”, which means they can provide Home Telehealth services using AMC Health’s CareConsole to VA-enrolled veterans and their families. This last step is very important because it is a common post-award point of failure for new awardees. Earlier this year, the Iron Bow/Vivify Health award failed on the country of origin of Vivify’s kit, dooming the implementation [TTA 16 Jan] and Iron Bow’s award. (Vivify Health has gone on.) Medtronic, as a long-term incumbent, has few worries in this regard, though any new equipment has to be cleared. The mystery is if Intel-GE Care Innovations, the last new awardee, has passed the ATO bar. AMC Health/1Vision release. 

And on the social front for New Yorkers, raise a Pint 2.0 at Aging 2.0’s NYC Happy Hour, Tuesday 18 July at 310 Bowery Bar, 6pm. Aging 2.0 website, where you can check for a chapter and events near you.

End of year action: Vivify/InTouch, InTouch/TruClinic, Medtronic, NYCEDC winners, ActiveProtective, Adidas exits wearables, Fitbit (updated)

  • Dallas-based Vivify Health is partnering with California’s InTouch Health to integrate their telehealth remote patient management with InTouch Health’s acute care video consult/device platform. For InTouch, it is a move into the home by using Vivify’s Managed Kit and BYOD and related APIs. For Vivify, this helps in their post-acute RPM sell to large healthcare organizations. (Is their VA partner Iron Bow somewhere in the mix?) Their VA Home Telehealth rival Medtronic announced their partnership with American Well a few months ago [TTA 21 Oct]. InTouch release via Telecom Reseller
  • Updated. InTouch also announced their agreement on Jan 4 to purchase DTC telehealth provider TruClinic furthering their move into home telehealth. TruClinic will be merged into InTouch. Heading it up will be recently appointed EVP of Marketing and Consumer Solutions Steve Cashman, who founded and headed pioneering but overly ambitious for the market health kiosk HealthSpot [TTA roundup here]. Release  (Our update on the state of health kiosks here)
  • Speaking of Medtronic Care Management Services, MCCM touted its VA Home Telehealth ties to Healthcare Analytics News. Intriguing claim: they’ve treated 310,000 veterans since 2011 (Cardiocom, the 2011 awardee, was purchased in 2013). VA itself credits only 156,000 patients to Home Telehealth in Federal FY 2014 (the last official count), 43,000 patients in 2010 and 144,000 in 2013. A very rough estimate by this Editor is that they were about 25 percent of the veterans in the program.
  • Announced at last week’s NYC Economic Development Commission (NYCEDC) Health 2.0 Digital Health Forum attended by this Editor were the winners of the third annual NYCEDC/HITLAB’s Digital Health Breakthrough Network accelerator program for pre-revenue startups: Altopax (VR behavioral health), Navimize (doctor/hospital scheduling), Tatch (sleep quality biometrics), and PainQX (pain level monitoring). The Forum also had Digital Health Marketplace matchmaking meetings for 65 NYC-based health tech companies with prospective clients. The Marketplace furnishes competitive grants to offset the cost of piloting between growth-stage tech companies and providers. Release, MedCityNews
  • ActiveProtective‘s controversial protective airbag to cushion hips from falls by high-risk older adults [TTA 10 Jan] gained $4.7 million in Series A funding led by Generator Ventures. Mobihealthnews
  • Adidas is shuttering its wearable device development unit and condensing its offerings, focusing on the Runtastic GPS-guided exercise offering and a shopping app. It follows similar moves at Nike and Under Armour proving that big names in sports fitness clothing couldn’t pull off wearables. Mobihealthnews
  • Meanwhile, Fitbit’s Ionic continues to develop with now an App Gallery with 60 apps–11 of which are health/fitness related–and more than 100 watch faces. (Wonder if any are Mickey Mouse?) What we termed a ‘Hail Mary’ pass may actually get past the goal line. Mobihealthnews

VA says goodbye to VistA, hello to Cerner for new EHR–and possible impacts (updated)

The new sheriff just turned the town upside down. Veterans Affairs’ new Secretary, Dr. David J. Shulkin, as expected moved quickly on the VA’s EHR modernization before the July 1 deadline, and moved to the same vendor that the Department of Defense (DoD) chose in 2015 for the Military Health System, Cerner. VA will adapt MHS GENESIS, based on Cerner Millenium. The rationale is seamless interoperability both with DoD and with private sector community providers and vendors, which base their services on commercial EHRs. The goal is to have one record for a service member through his or her lifetime and to eliminate the transition gap after discharge or retirement. (Transition gaps are also repeated when reservists or National Guard are called up for active duty then returned to their former status.) Another priority for VA is preventing the high rate of suicide among vulnerable veterans.

Updates: VA confirmed that Epic and Leidos will keep the development of the online medical appointment scheduling program, awarded in 2015 and currently in pilot, to be completed in 18 months. The contract is worth $624 million over five years. Wisconsin State Journal  The House Appropriations subcommittee on Veterans Affairs likes the Cerner EHR change. The Senate Veterans Affairs Committee is meeting Wednesday to discuss the VA budget sans the EHR transition. The EHR numbers are expected to be sooner rather than later. POLITICO Morning eHealth 

Dr. Shulkin is well acquainted with the extreme need for a modernized, interoperable system serving the Veterans Health Administration (VHA), having been on the US Senate Hot Grill for some years as Undersecretary of Health for VA. The foundation for the move from homegrown VistA to Cerner was laid last year during the prior Administration through an August RFI for a COTS (commercial off the shelf) EHR [TTA 12 Aug 16] and in later hearings. “Software development is not a core competency of VA” and it has been obvious in system breakdowns like scheduling, maintaining cybersecurity and the complex interoperability between two different systems. To move to Cerner immediately without a competition, which took DoD over two years, Dr. Shulkin used his authority to sign a “Determination and Findings” (D&F) which provides for a public health exception to the bidding process. The value of the Cerner contract will not be determined for several months.

For those sentimental about VistA, he acknowledged the pioneering role of the EHR back in the 1970s, but that calls for modernization started in 2000 with seven ‘blue ribbon’ commissions and innumerable Congressional hearings since. He understated the cost in the failed efforts on interoperability with DoD’s own AHLTA system, VA’s own effort at a new architecture, and modernizing the outpatient system. This Editor tallied these three alone at $3 billion in GAO’s reckoning [‘Pondering the Squandering’, TTA 27 July 13]. 

It is still going to take years to implement–no quick fixes in something this massive, despite the urgency.

  • Both MHS and VA will be running two systems at once for years (more…)

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

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…)

ONC gets in study game in designing the Consumer Centered Telehealth Experience

ONC (the Office of National Coordinator for Health Information Technology, HHS) in the spring conducted a design session on creating a more consumer-centered telehealth experience, commissioning the engagedIN research firm to help select a panel, run it and produce the study. The white paper focuses on how telehealth can either further fracture or integrate PHR (study pages 7-11), and what’s needed to make telehealth and telemedicine more convenient and effective for consumers. The panel avoided the big telemedicine providers (a bone that Mobihealthnews picks with the study) which typically dominate these panels–to this Editor a positive action–but included other telehealth providers like Qualcomm Life, Care Innovations and Zipnosis, as well as the US’ largest user of telehealth, VA Home Telehealth. Among the key drivers of telehealth are HHS’ and private insurers (UHC) shift to value-based payments; CMS’ target of 50 percent of Medicare value-based care is cited (page 5). There are nine principles at the end (pgs 13-16) to guide the way forward. Designing the Consumer Centered Telehealth and e-Visit Experience (PDF) (Though it is confusing why e-Visit was used rather than ‘virtual visits’ or, in fact, telemedicine.)

Breaking news confirmed: Bosch exiting healthcare and telehealth in US–UPDATED

Breaking News–UPDATED with Bosch response

Bosch has confirmed they are closing their telehealth business in the US. Please see their statement at the end of this article.

A home care industry newsletter, along with our own reliable industry sources, have confirmed the recent industry discussion that Bosch Healthcare, since January a solely US operation, is winding down its business without a definite turnover to a buyer. This Editor, in calling various departments in their Palo Alto, California offices for confirmation on Thursday, was (when she reached a human being) forwarded to HR where she could leave only voice mail. An email to marketing also received no response. All sources indicate that staff layoffs took place last Monday.

Editor’s Note: Bosch’s official press response follows this article. We have also made certain corrections to this article (see in red).

  1. The Home Care Technology Report, published by industry consultant Tim Rowan, on Wednesday posted two articles stating that Bosch laid off nearly all of its staff on Monday (15 June) save for customer service and some key operating areas. His information indicated that Health Buddy sales–new and existing orders–have been terminated. This includes orders placed through its McKesson partnership. Non-VA service will be terminated in 60 to 90 days.
  2. Home Care Technology also reported that Bosch’s business with the Veterans Health Administration (VA) will be maintained through April 2016, which is near to the contract end in May, but no new units will be delivered. The original contract was with Health Buddy hub developer Health Hero Network, sold to Bosch in 2008With the later acquisition of ViTel Net, Bosch developed into one of the two leading VA Home Telehealth remote monitoring hub suppliers–the other being Cardiocom. VA Home Telehealth is the largest telehealth program in the US with over 156,000 patients (Federal Year 2014) (Ed. Note: VA has a third authorized and active VA supplier, Viterion).

As Mr Rowan did, this Editor will speculate on the reasons why there is this reported exit without a sale or spinoff, despite the substantial VA and other healthcare placements of Health Buddy. Our take is somewhat different than his: (more…)