VA, DoD aren’t collaborating on EHR: GAO

February 28, 2014 | by

Your ‘Dog Bites Man’ item for the weekend (no, it’s not in reverse!) is that the Government Accountability Office (GAO) has determined that Veterans Affairs (VA) and the Department of Defense (DoD) have not yet proved that their current two-system path, having rejected a single EHR, actually will be workable. In February 2013, both agencies abandoned a joint system after $1 billion in spend, and $4 billion in fixes/upgrades to their separate VistA and AHLTA systems. [TTA 15 Dec] By the two agencies going their separate ways, the GAO is mystified on what is going on with interoperability. The answer: not much. And as mentioned in our 15 December article, there was a 31 January deadline for an interoperability plan (or single system) to be implemented by 2016, mandated by the 2014 National Defense Authorization Act (NDAA). Obviously, this deadline has come and gone. FierceEMR article, GAO recommendation (full text PDF)

One way to overcome the interoperability problem and too much in the EHR? Get rid of those pesky backlogged patient records! The Daily Caller uncovered a VA whistleblower’s complaint to the VA’s Inspector General and their office of special counsel, plus Congress, that VA officials in Los Angeles intentionally canceled backlogged patient exam requests going back more than one year–and that the delay on exams went back 6-9 months. The deletions started in 2009. There is a wrongful dismissal (of said whistleblower) suit and other joy. Article, audio (02:21) Updates 3-4 March:  according to Under Secretary for Health Robert Petzel, the Daily Caller report was ‘scurrilous’. He stated that about 300 records were closed but not deleted after administrative review, generally for old imaging requests, and there was no effort to delete records to boost performance.  According to FierceHealthIT, the backlog is about 400,000. Also Military Times. According to EHR Intelligence, both DoD and the VA agree with the GAO recommendations; GAO will update its findings once the agencies have taken action. Also iHealthBeat.

Powerhouse DC lobbying for telehealth, telemedicine

February 13, 2014 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye observes from a houseboat anchored at a remote Pacific island, with coconuts and occasional internet to Editor Donna.

Telehealth and telemedicine have reached a US milestone of sorts: the formation of a Washington, DC-based ‘advocacy’ (a/k/a lobbying) group constituted as a business non-profit. The Alliance for Connected Care is headed by three former Senators (two of whom were ‘amigos’) from both sides of the aisle and backed by a board including the expected (giants Verizon, WellPoint, CVS Caremark, Walgreens)–and the surprising (much smaller remote consult provider Teladoc and HealthSpot, the developer of the HealthSpot Station kiosk–hmmm, must be a fair chunk of their marketing budgets there) flanked by six well known ‘associate members’ including Cardinal Health and Care Innovations (another hmmm). There’s also a hefty ‘advisory board‘ including the American Heart Association and the NAHC (home care). The leadership team members are all members of major Washington law/lobbying firms. Tom Daschle is recognized as one of the most influential former Senators in town via DLA Piper, though himself not a registered lobbyist (OpenSecrets.org). Trent Lott and John Breaux hung out their own shingle and were recently bought by mega-lobbyist Patton Boggs. To put a fine point on it, more high-powered one does not get. The Eye sees that the time is prime for the Big Influence and…

What the Eye sees is Big Financial Stakes: Private insurers are required to cover telehealth in 20 states, as does Medicaid in most. The VA is a major user. But the great big trough of Medicare is new territory; covering 16 percent of the population, the use of telemedicine and telehealth is limited to certain geographic areas. (MedCityNews) This marks the infamous tipping point: the clarion call to ‘build significant and high-level support for Connected Care among leaders in Congress and the Administration’, ‘enable more telehealth to support new models of care’ and ‘establish a non-binding, standardized definition of Connected Care through federal level multi stakeholder-input process’ (whew!) Big companies want in, insurers want reimbursement, and they want it from somewhere as well. Toto, we’re not in the Kansas of Small anymore with ‘connected health’–we are now in the Oz of Big Money and Power Players. Alliance release (Oddly the website looks preliminary despite the big announcement and backing.)

More on this strategy: It’s called ‘soft lobbying’ and it is the latest thing in the Influence Wars. The Alliance for Connected Care is a 501(c)6 non-profit, similar to a business league like the Chamber of Commerce, and this has become a popular tactic. It’s also a less regulated, less transparent way to shape coverage, public opinion and exert influence on legislators. See this well-timed examination from the Washington Post on the corn syrup versus table sugar wars. ‘Soft lobbying’ war between sugar, corn syrup shows new tactics in Washington influence

Telepsychiatry: a new practitioner’s experience

January 27, 2014 | by

Daniel W. Knoedler, MD in Psychiatric News chronicles his first week as a full-time telepsychiatrist, working for the Green Bay VA Hospital in Green Bay, Wisconsin. He is definitely a bit stressed as he adjusts to working alone in a cold basement, his image in the video system and the Loneliness of the Long-Distance Psychiatrist who doesn’t have face-to-face contact with patients–and his own socialization. Yet he thinks telemedicine is useful in addressing the lack of access to care for patients and that the technology is not much of a barrier. He does worry about the consequences of not shaving, leading to some musings on Howard Hughes.  Telepsychiatry: First Week in the Trenches

Telecare – time to lose the last “e”?

January 12, 2014 | by | 1 Comment

Many years ago when I co-founded eForum to promote what was then called “eGovernment”, it was common for smart speakers to begin their conference presentations by saying that it’d soon be plain “government”, which indeed it has been now for many years; around the world, government sector workers have embraced technology to offer huge improvements in quality of service to citizens at reduced cost. Sadly health services have proved far more resistant to the beneficial use of technology, so eHealth & mHealth seem likely to take rather longer to lose their prefixes, in spite of pleas from the VA. If any support for this view was needed, the telehealth news from the flat earth society of a recent survey of GPs (more…)

NIH-NFL research grants on brain injury awarded (US)

December 19, 2013 | by

In September 2012, the National Football League (NFL) donated $30 million to the Foundation for the National Institutes of Health (FNIH) to focus on brain injury. The Sports and Health Research Program (SHRP) now has a somewhat wider scope inclusive of joint diseases, sudden cardiac arrest, sickle cell anemia and hydration/heat injury. Last week they announced eight projects to be supported. Two ($6 million each) are cooperative agreements focusing on brain injury and after multiple concussions. These research projects are:  Boston University, which has pioneered major CTE research [TTA 5 June], and the VA on CTE; the pathology of CTE and delayed TBI from Mount Sinai Hospital in New York City. The six other studies are ‘pilots’ totalling about $2 million over two years and range from cortical GABA in pediatric sports concussion, the Spot Light concussion management app developed by Inlightened, LLC, and eye movement tracking for concussion detection. FNIH release

EHR interoperability redux for VA, Department of Defense (US)

December 15, 2013 | by

Back in late February, the US Department of Defense and Veterans Affairs announced that they would not achieve their goal of a single EHR by 2017, and would stick with their creaky AHLTA and VistA systems for the foreseeable future [TTA 3 April]–along with the general lack of interoperability–eyes rolled at the $1 billion down the drain, but seemingly not much else budged. (And this does not include the $4 billion spent on failed updates and fixes in both systems–TTA’s ‘Pondering the Squandering’, 27 July) To this Editor’s utter shock, the 2014 National Defense Authorization Act (NDAA), agreed to by the House and Senate this week, mandates a plan for either interoperability or a single system by 31 January–about 6 weeks from now–and to adopt it by 2016. Moreover, both systems must be interoperable with private providers based on national standards by 1 October 2014. A close reading of the NextGov article indicates that the bill adds levels of complexity and perhaps unworkability. Getthereitis, anyone?–or does this sound like Healthcare.gov, redux? FierceMobileHealthcare

And it takes a grad student to find a major info security flaw in VistA.  (more…)

Exoskeleton to aid paraplegic in charity walk (US)

November 21, 2013 | by

This past Sunday, architect Robert Woo walked a mile in NYC’s Riverside Park for Generosity NYC 5K. Now that would not be remarkable at all except that Mr. Woo is a paraplegic, and he is walking that mile with the aid of an Argo ReWalk exoskeleton. He and his ReWalk-equipped teammates are raising funds as Team ReWalk to aid the Bronx Medical Veterans Research Foundation/James J. Peters VA Medical Center’s Exoskeletal-Assisted Walking Program. Mr. Woo’s story is a memorable and courageous one from the time of his injury in a horrific construction-related accident six years ago; more in Paralyzed By Seven Tons Of Steel, Man Now Walks With A Bionic Suit (Gothamist). Video in this local CBS News clip. This is certainly the most developed version of an exoskeleton and robotics to enable paraplegics to walk, yet it is still not easy and requires specialized training; most exoskeletons to date have concentrated on assisting lower body movement. Hat tip to Donald Andrews of New York-Presbyterian/Lev El Medical via LinkedIn Groups.

Bill to expand military telehealth services introduced (US)

November 19, 2013 | by

Two House representatives from California, Mike Thompson (Congressional District 5) and Scott Peters (District 52) have introduced HR 3507, the 21st Century Care for Military & Veterans Act. This expands coverage of telehealth services (including remote monitoring and virtual consults/telemedicine) for active-duty service members, their dependents, retirees and veterans, including physician reimbursement for telehealth services under TRICARE (the health plan for active duty and military retirees) and the Department of Veterans Affairs (VA). (more…)

Mental health apps for veterans (US)

November 13, 2013 | by

The US Department of Veterans Affairs (VA) has signed a 12 month contract with Chicago-based Prevail Health Solutions to further develop the Vets Prevail online supportive behavioral health program in 2014. In development for five years in various pilots, it has corporate support from Goldman Sachs Gives, the Robin Hood Foundation. the Bristol-Myers Squibb Foundation and PepsiCo. Vets Prevail is an online program using Cognitive Behavioral Therapy (CBT)-based e-learning lessons and peer-to-peer support, also routing into select established Veterans Health Administration resources. Mobihealthnews profiles the 10 apps Prevail is using plus others that the VA has developed such as PTSD Coach, smoking cessation app Stay Quit Coach and Care4Caregiver.

VA Department data breaches soar (US)

October 14, 2013 | by

If after the Healthcare.gov debacle, there’s still any confidence that centralized Federal systems are secure and trustworthy, please read this HealthcareITNews tally of the multiple data breaches and HIPAA violations taking place at the US Department of Veterans Affairs (VA).

From 2010 through May 2013, VA department employees or contractors were responsible for 14,215 privacy breaches affecting more than 101,000 veterans across 167 VA facilities, including incidences of identity theft, stealing veteran prescriptions, Facebook posts concerning veterans’ body parts, and failing to encrypt data, a Pittsburgh Tribune-Review investigation revealed.

The two-month investigation by the Pittsburgh Tribune-Review published this weekend found that the VA led the way in HIPAA violations–17 in the past few years–for reasons centering on lack of accountability, shoddy safeguards, sloppiness in handling data and failure to encrypt data even after the 2006 theft of a laptop put records of 26.5 million veterans in danger. There are few firings, disciplinary actions or HHS fines.

This should put telehealth and telemedicine providers on notice that their encryption will have to be ‘stronger than the VA’, as both they and Department of Defense (DOD) are the single largest users of telehealth in the US.

Best Practice 2013–Birmingham

September 30, 2013 | by

16-17 October, Birmingham NEC

Targeted to GPs, Clinical Commissioners, practice managers and other decision makers, the conference will focus on delivering sustainable change in Primary Care and examining how commissioners can turn international best practice into local NHS reality. According to the organisers, telehealth-facing content includes key lessons learnt from the NHS Exchange Programme with the US Veterans Health Administration, a global leader in adopting digital health including telehealth to improve patient outcomes. Information.

Conflicting telehealth signals – is the VA or E Riding of Yorkshire CCG on the money?

September 9, 2013 | by | 4 Comments

Can there be two greater contrasts than the recent decisions by the Dept of Veteran Affairs in the US (VA) to award a five year $28.8m telehealth contract to AMC Health and that of the E Riding of Yorkshire CCG to “axe” its telehealth service?

The sheer size of the VA deal makes every recent deal in Europe seem very small in comparison. AMC’s CEO said: “AMC Health’s outcomes-based approach to telehealth and ability to actively engage patients to proactively self-manage their chronic conditions perfectly aligns (more…)

Systems sharing data, still behaving badly

August 7, 2013 | by

A straight-shooting article in Healthcare Technology Online provides a overview of the EHR and Health Information Exchange (HIE) mess in the US. Essentially our major EHR systems (Cerner, McKesson, athenahealth, Greenway, Epic) don’t interchange data well, if at all–and the 600-odd practice EHRs were built on siloed designs, existing software and used proprietary formats, often in a rush to take advantage of Federal subsidy programs in Stage 1 Meaningful Use–as HTO’s EIC Ken Congdon stated, “electronic filing cabinets”–and heavily outsourced. Well, it’s now ‘uh-oh’ time as a key part of Stage 2 MU is interoperability. Basically we now have a set of what this Editor would term ‘paste ons’ and ‘add-ins’ to facilitate data exchange between systems that speak different languages (Editor’s emphasis):

…direct protocol (a standards-based method for allowing participants to send authenticated and secure messages via the National Health Information Network), as well as those developed by HL7 (Health Level Seven), a nonprofit global health IT standards organization, provide EHR users with the building blocks for exchanging data. Blue Button, an application developed by the VA that allows patients to download their own health records, is also being adopted and manipulated by EHR vendors and independent developers as a way for providers to exchange data between systems. Moreover, regional and state-run HIEs offer healthcare providers in several parts of the country a network they can join (and technology infrastructure they can leverage) to share health data with other HIE members.

Some systems work well–EHR and pharmacy systems seem to. However, EHR to EHR interfaces are up to the provider and are expensive. Sharing/translation does not mean that all information makes it over without getting ‘bruised’ or having to be reentered manually.  HIEs, acting as a focal point for data exchange, are also generally non-profit; the exchange platforms cost millions to develop and further millions to maintain–and buy-in is low, as the article states. Fixing The EHR Interoperability Mess (free registration may be required)

(Updated 8/7 pm for Editor Donna’s POV) This is what happens when you rush adoption and development processes that should take years in order to gain quick subsidy money, and non-healthcare entities (that is you, the US Government) encouraged this, distorting the process. The private and public waste of scarce healthcare funds is appalling, and the disruption to the healthcare system is unforgivable–especially in practices where doctors and managers in many cases have been sold a bill of goods, and they are revolting by changing EHRs, going back to paper or retiring. And the Government should look to itself first. Look no further than to the multiple failures of two branches of the US government, Veterans Affairs and Department of Defense, which have the responsibility for current and veteran members of our Armed Services. They have failed spectacularly in serving Those Who Have Served not only the integration of their two EHRs but also in updating their basic architecture [TTA 27 July ‘Pondering the Squandering’… and 3 Apr ‘Behind the Magic 8 Ball’ both review the sad details.] The belief that HIEs with limited funding will solve the interoperability problem is Magic Thinking. At least one move in this direction makes sense: the CommonWell Alliance of six EHR heavy hitters to work on ‘data liquidity’ [TTA 5 Mar announced at HIMSS], but this may be another ‘uh-oh’ and face saving.

With basic, necessary health and patient information stuck in systems and getting lost in translation, how can anyone rationally expect that personal data from telehealth devices will be integrated anytime soon, in any meaningful way? Does this mean that parallel, separate systems and platforms will continue to develop–and yet another wave of integration?  

Encouraging adoption of telehealth by clinicians x 3

August 5, 2013 | by

At the Royal Society of Medicine every year there is a medical students careers fair at which the Telemedicine & eHealth Section runs a stand.  Unlike other sections such as cardiology and general practice, we don’t see telehealth and other related technologies offering a career for many – the stand is purely to raise awareness because, scary as it may sound, many of the students who have visited us in recent years have never been taught about these technologies at medical school.  It is therefore good to see an article by Ben Heubl in Medcrunch, an online magazine aimed at tech-savy young doctors, discussing the reasons for slow adoption of telehealth (and telecare) which in part built on a meetup of the London Health 2.0 chapter last week.

In this context it’s also worth mentioning an article by Atul Gawande in the New Yorker on why some medical innovations spread fast, and other slowly.  He begins by contrasting the rapid adoption of anaesthesia with the slow adoption of antiseptics, both of which were discovered at about the same time.  From this he draws the lesson that where doctors see a clear benefit – in the case of anaesthesia, no longer having a patient struggling and screaming whilst being operated on – the adoption was fast.  Where the immediate benefit is harder to see and in particular it challenges the modus operandi – washing hands, sterilising instruments and replacing frockcoats caked in blood for clean white operating gowns – as with antiseptics, adoption was much slower even though the impact on patient outcomes was dramatic.   This not in any way a complete summary though – I would urge you to read this excellent piece in its entirety as there are many nuances…and important lessons for the future.

Rounding this post off, Pulse has just introduced a GP Guide to Telehealth (written and funded by MSD) which is short and to the point, balancing the UK experience of the Whole System Demonstrator with the very positive experiences of the Department of Veterans Affairs.  Much to be welcomed and with the added bonus of CPD points too.

Pondering the squandering of taxpayer money on IT projects (US)

July 27, 2013 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye has been in Observation Mode this week. But this handful of Dust-In-Eye necessitates a Benny Goodman-style Ray on another US governmental ‘fail’. When it comes to IT, the government admits…

Agencies Have Spent Billions on Failed and Poorly Performing Investments

Exhibit #1: FierceHealthIT summarizes five big ones out of a 51-page Government Accountability Office (GAO) report focusing on the inefficiency of agency IT initiatives–just in healthcare.

  1. Veterans Affairs (VA) VistA EHR system transitioning to a new architecture: terminated October 2010 at a cost of $1.9 billion
  2. VA-Department of Defense (DOD) iEHR integration: as previously written about, it collapsed under its own weight for another $1 billion [TTA 8 March]

  3. DoD-VA’s Federal Health Care Center (FHCC). Opened in 2010 as a joint facility under a single authority line, but somehow none of the IT capabilities were up and running when the doors opened. ‘Jake, it’s ChiTown.’ Only $122 million.

  4. DoD’s own EHR, AHLTA (no VistA–that’s VA’s) still doesn’t work right; speed, usability and availability all problematic. A mere $2 billion over 13 years.
  5. VA’s outpatient system is 25 years old. Modernization failed after $127 million over 9 years before the plug was pulled in September 2009

You’ll need Iron Eyes to slog through the detail, but it is a remarkable and damning document. PDF (link)

but…there’s more. Excruciating, hair-hurting, and would be amusing if not so painfully, and expensively, inept. Malware Removal Gone Wild at Commerce… (more…)