News roundup: VillageMD sued on Meta Pixel trackers; Cerebral pays $7.1M FTC fine on data sharing, cancellation policy; VA may resume Oracle Cerner implementation during FY2025; Epic-Particle Health dispute on PHI sharing

April 16, 2024 | by

It’s all about personal health data–sharing, bad sharing, and bad transfers in this roundup.

VillageMD takes another hit, this time on Meta Pixel ad tracker issues. A class-action lawsuit filed on 10 April charges VillageMD (formally Village Practice Management Company), via its Village Medical website, of using the Meta Pixel ad tracker for disclosing user-protected health information (PHI) and other identifiable information generally classified as PII. This included visitors to their website villagemedical.com seeking information and patient users of Village Medical’s web-based tools for scheduling and the patient portal. The lawsuit by a “John Doe”, a patient since January 2023 resident in Quincy, Massachusetts but brought by three Midwest law firms in the US District Court for the Northern District of Illinois, states that VillageMD used trackers that transferred this personal information to Meta Networks’ Facebook and Instagram, as well as other third parties like Google, for use in targeted advertising, in violation of HIPAA and other regulations. The lawsuit seeks 1) an injunction stopping Village Medical from using ad trackers and 2) monetary redress via damages–actual, compensatory, statutory, and punitive for the entire affected class. The suit also alleges that VillageMD violated its own internal procedures. Crain’s Health Pulse, Healthcare Dive

Readers will recall that in June 2022, STAT and The Markup published a study and follow-ups on Meta Pixel and ad tracker use by healthcare organizations. Ostensibly, the ad trackers were there to better track website performance and to tailor information for the patient [TTA 17 June, 21 June 2022], but they sent information to third parties that violated HIPAA and privacy guidelines. Ad trackers were also monetized. Meta blamed the health systems [TTA 16 May 2023] for misuse though they used the data for ad serving.  Congressional hearings, FTC, and DOJ followed later in 2022 and 2023. Multiple class action lawsuits against providers large and small have ensued. Providers have pushed back on FTC and HHS rules on ad trackers, stating the restrictions hamper their ability to build better websites based on customer usage and to serve individuals with useful information. 

Another ‘oversharing’ company, troubled telemental Cerebral, whacked with $7.1 million FTC fine on disclosing consumer information via ad trackers plus ‘negative option’ cancellation policy. The proposed order for a permanent injunction filed by the Department of Justice (DOJ) and docketed on 15 April has to be approved by the Federal District Court for the Southern District of Florida. The fine for the company only penalized the following:

  • Cerebral released 3.2 million consumers’ information to third parties such as practices, LinkedIn, and TikTok. This included PHI and PII such as names, medical histories, addresses, IP addresses, payment methods including insurance, sexual orientation, and more. Even more outrageously, they also used the mail for postcards that had sensitive information such as diagnosis printed on them. The insult on injury was that Cerebral failed to disclose or buried information on data sharing to consumers signing up for their ‘safe, secure, and discreet’ services. Cerebral now has to restrict nearly all information to third parties.
  • Cerebral also set up their service cancellation as a ‘negative option’ cancellation policy, which in reality meant that it was renewed indefinitely unless the customer took action to cancel. It was not adequately disclosed in violation of the federal Restore Online Shoppers’ Confidence Act (ROSCA). Then Cerebral made it extremely difficult to cancel by instituting a complex procedure that required multiple steps and often took several days to execute. They even eliminated a one-step cancel button at their then-CEO Kyle Robertson’s direction. The order requires this to be corrected including deleting the negative option.
  • Former employees were not blocked from accessing patient medical records from May to December 2021. It also failed to ensure that providers were only able to access their patients’ records.

Cerebral’s settlement with the FTC and DOJ breaks down to $5.1 million to provide partial refunds to consumers impacted by their deceptive cancellation practices. They also levied a civil penalty of $10 million, reduced to $2 million as Cerebral was unable to pay the full amount. The decision and fine do not cover charges to be decided by the court against the former Cerebral CEO Robertson due to his extensive personal involvement in these practices. Those have not been settled and apparently were severed from the company as a separate action (FTC case information). Since 2022, Mr. Robertson has consistently blamed company management and investors for pushing for bad practices such as prescribing restricted stimulant drugs. Cerebral countersued him for defaulting on a $49.8 million loan taken in January 2022 to buy 1.06 million shares of Cerebral common stock. More to come, as the order also does not address other Federal violations under investigation, such as those under the Controlled Substances Act.  FTC release, FierceHealthcare  

VA to possibly resume Oracle Cerner EHR implementation at VA sites before the end of FY 2025, even if not in budget. During House Veterans’ Affairs Committee hearings on FY 2025 and 2026 budgets, VA Secretary Denis McDonough last Thursday (11 April) said that the VA intends to resume deploying the Oracle Cerner EHR as part of VA’s Electronic Health Records Modernization (EHRM) before the end of FY 2025. As Federal years go from October to September, FY 2025 starts October 2024 and ends September 2025. When asked if VA plans to maintain the “program reset” as they termed it in April 2023 for all of FY25, Secy. McDonough said that “we do not.”However, there is no budget allocated for additional implementations in either FY. The plan is to use carryover funding.

Oracle Cerner’s Millenium EHR was implemented at five VA locations before suspending in April 2023 for a massive re-evaluation which involved reworking systems such as the Health Data Repository which created critical scheduling and pharmacy problems detailed by the Office of Inspector General (OIG)  [TTA 28 Mar]. The joint VA and MHS/Genesis Lovell FHCC implementation, which went live in March, is not included.  NextGov/FCW, Healthcare Dive

And in another dispute about data sharing, leading EHR Epic cut off requests made by some Particle Health customers, expressing concern about privacy risks. Particle Health is a health data exchange API platform for developers. Both Epic and Particle are part of Carequality, a large scale data exchange group that connects 600,000 care providers, 50,000 clinics, and 4,200 hospitals to facilitate the exchange of patient medical records On 21 March, Epic filed a dispute with Carequality that some of Particle’s users “might be inaccurately representing the purpose associated with their record retrievals.” and stopped responding to some Particle Health customer queries. This has now degenerated into a ‘who said what‘ dispute, with Particle and their CEO alleging that Epic implied that it completely disconnected Particle Health and its customers from Epic’s data, while Epic has said that after a review by its 15-member Care Everywhere Governing Council, they flagged three companies who were using Particle’s Carequality connection to access data not related to patient care or treatment. There’s also a larger concern being brought up by providers on the use of these mass data exchanges for fraudulent extraction of data or use that would violate HIPAA guidelines. FierceHealthcare, CNBC, Becker’s, Morningstar

Short takes: PocketHealth, Brightside fundings; VA OIG reports hit Oracle Cerner; Change cyberattack/legal updates; UHG-Amedisys reviewed in Oregon; Optum to buy Steward Health practices

March 28, 2024 | by

It’s a relatively quiet week before the Easter holiday, with a few fundings, more drama at the VA around Oracle Cerner, updating Change Healthcare’s comeback, and the continuing scrutiny around UnitedHealth’s acquisitions:

PocketHealth garners a US$33 million Series B. The Toronto-based company markets an AI-assisted platform to health systems and providers that allows patients to access their medical imaging and reports as well as for providers to easily share imaging information. The funding was an all-equity round by Round13 Capital with participation from Deloitte Ventures, Samsung Next, and existing investors Questa Capital and Radical Ventures to bring total funding since 2020 to $55.5 million. The fresh funding will be used to grow further within the US and Canada and develop new platform functions. Patients have access to three platforms:  Report Reader to explain medical terms in the patient’s report, Follow-Up Navigator for follow-up imaging recommendations, and MyCare Navigator to equip patients with relevant, personalized questions to ask their doctor. The platform is available in 775 hospitals and imaging centers across North America and is used by more than 1.5 million patients.  PocketHealth release, Mobihealthnews

Brightside Health moves to a Series C of $33 million. This round for the telemental health company was led by S32, along with Kennedy Lewis, Time BioVentures, and Anne Wojcicki (Redwood Pacific) with existing investors ACME, Mousse Partners, and Triventures. Total funding since 2018 is $114 million. Brightside provides telemental health through payers in 50 states such as CareOregon, Blue Cross and Blue Shield of Texas, and Centene. The new funding will be used to expand into the usual new markets and offerings. Trip Hofer, who was former CEO of Optum Behavioral Health Solutions and now with .406 Ventures, will join the Brightside board of directors. Their most recent moves are expansion into Medicare and Medicaid programs for psychiatry, therapy, and their Crisis Care program for individuals with elevated suicide risk. Release

The Department of Veterans Affairs Office of Inspector General (OIG) released three reports last Thursday (20-21 March) that were sharply critical of the new Oracle Cerner EHR. While Oracle Cerner Millenium operates in only five VA locations, not including the joint MHS/Genesis Lovell FHCC, each one has been problematic from training to implementation–and are on hold. The OIG reports available here on the Electronic Health Records Modernization (EHRM) are scathing on the EHR’s scheduling and pharmacy features leading to patient safety and staff usability issues.

  • At VA Central Ohio Healthcare System (facility) in Columbus and elsewhere, this led to inaccurate medication and allergy information transmission from new EHR sites to legacy EHR sites that staff and pharmacists had to work around to provide adequate safety checks.
  • Also at VA Central Ohio, the Cerner EHR system error in 2022 led to a patient’s missed appointment since it was not routed to a queue to prompt rescheduling efforts. Subsequently, a nurse practitioner never evaluated the medication refill request, nor did a psychologist evaluate mental status and critical clinical information. The veteran patient died by accidental overdose approximately seven weeks after that missed appointment.
  • Regarding future implementations, the OIG was specific on what had to be fixed on both: “These concerns include the need for additional staffing and overtime to meet or exceed pre-deployment appointment levels, displaced appointment queue functionality, challenges related to providers and schedulers sharing information, inaccurate patient information, difficulties changing appointment type, and the inability to automatically mail appointment reminder letters. At facilities currently relying on the EHR, these issues have resulted in inconsistent workarounds and additional work, increasing the risk for scheduling errors.” 

Healthcare IT News, Healthcare Dive, EHR Intelligence, TTA 22 Feb

Change Healthcare’s systems are gradually returning. Since our last update on 14 March, UnitedHealth Group confirmed that 99% of pharmacy network services were up and running–and that they have fronted $2 billion to providers. Separately, they launched workaround software for medical claims preparation.

  • On 15 March, the electronic payments platform was restored.
  • On 20 March, UHG restored Amazon Web Services. It was backed up from Assurance, a claims and remittance management program, and claims clearinghouse Relay Exchange.
  • Relay Exchange went back online by 24 March to begin processing $14 billion in medical claims.

But on the legal and Federal fronts, UHG will be keeping its legal department busy. Starting the week of 11 March, the first class action lawsuit was filed by a women’s health practice in Albany, MS–Advanced Obstetrics & Gynecology PC. Another class action suit was filed on 18 March by Gibbs Law Group on behalf of providers to be named. Patients who have had compromised PII and PHI will be next from the 4 or 6 terabytes of payer information held by ‘notchy’ and other affiliates from the BlackCat/ALPHV masterminded attack as this is confirmed. Expect these to multiply like weeds in May. HIPAA Journal  And the American Hospital Association, Senators and House Representatives are jumping all over Health and Human Services (HHS) to ensure that payments are made to Medicare, Medicaid, and Medicare Advantage plans–as well as calls for investigating UnitedHealth. Becker’s, FierceHealthcare

As expected, UHG’s acquisition of Amedisys home health is running into more opposition at the state level. In this case, it’s the Oregon Health Authority (OHA) that will be conducting a full review. The Department of Justice (DOJ) has been investigating the acquisition on antitrust grounds almost since it was announced in June 2023. Shareholders approved the $3.3 billion buy the following September, but it has not closed. UHG’s plan is to merge it into Optum’s home health providers Contessa Health and LHG Group, creating a home health juggernaut. As noted earlier this month when DOJ announced a further antitrust probe of UHG around the UnitedHealth plan relationships with Optum services, “DOJ has a long memory, a Paul Bunyan-sized ax to grind, and doesn’t like losing. One wonders if now UHG has buyer’s remorse after fighting for two years to buy Change.” (And winning versus DOJ!) Fierce Healthcare

Yet UHG goes on buying providers, DOJ scrutiny or not. Optum is bidding for Steward Health Care’s Stewardship Health practices over nine states. For-profit Steward, headquartered in Dallas, needs to raise funds as it is in debt overall and facing major problems in Massachusetts, with several hospitals at risk of closure. In any case, the company wants to exit the state. A purchase price was not announced. The transaction is under review by Massachusetts’ Health Policy Commission (HPC) over the next 30 days. The Stewardship transaction would add to OptumCare’s total of 90,000 physicians–10% of US physicians, a number that is raising red flags on the state and Federal levels. FierceHealthcare, WBUR

News roundup: Cerner goes live at VA, DOD Lovell Center; WebMD expands education with Healthwise buy; Dexcom has FDA OK for OTC glucose sensor; Centene may have buyer for abandoned Charlotte HQ

March 12, 2024 | by

In news other than Walgreens and Optum/Change Healthcare–with more to come out of HIMSS in Orlando this week…

The DOD/VA Cerner EHR went live on Saturday 9 March in the Capt. James A. Lovell Federal Health Care Center (Lovell FHCC), right on scheduled time. This EHR which will serve both active duty service members in the Military Health System (MHS) and veterans through the VA is being watched closely. While MHS Genesis has been rolled out in most military health facilities in the US and overseas, the VA’s has stalled at five. As of now, Lovell is the only VA implementation planned for this year and its functionality and interoperability with MHS is under a microscope. Training has been intensive and VA reports having made many changes from the earlier implementations. The MHS Genesis team from DOD have also been a key part of the training.

VA has shown improvement with no full outages in 300+ days and with the nagging smaller incidents greatly reduced. But the VA’s deputy inspector general reported significant and dangerous faults in the Oracle Cerner Millenium medication record system only last month to the House Subcommittee on VA Technology Modernization [TTA 22 Feb]. While the fixes are in effect in the five VA locations with Millenium, Genesis at Lovell will not have them yet.

Lovell FHCC is located in north Chicago, has a combined DOD/VA staff of 3,200, and serves 75,000 patients per year: 25,000 veterans, over 10,000 TRICARE enrollees, and 30,000 Navy recruits from Great Lakes with a 300-bed main facility and clinics in the Chicago area. Federal News Network

WebMD buys health education developer Healthwise. The company’s patient education assets including content and technology that integrate into care management platforms for both health systems and payers will become part of WebMD Ignite, which was formed last April to unite Krames, also in health education, Mercury Health data analytics, Wellness Network videos, Vitals provider scheduling, in addition to Medscape and WebMD. According to the release, the combination of Krames and Healthwise will reach 650 healthcare organizations, comprising more than 50% of hospitals in the U.S. and 85% of the top 20 payers, which is a dominant market share with limited other competition such as Wellframe, owned by HealthEdge. Transaction cost, surviving name, and management/staff transitions were not disclosed.

Healthwise is unusual in that it was formed as a non-profit in Boise, Idaho in 1975. In the 2024 Best in KLAS Report, Healthwise was ranked first in health education for value-based care. While the education assets are being sold to WebMD, the non-profit will go on, according to Healthwise. Healthcare IT News (Editor’s disclaimer: Donna was a consultant for Krames on marketing projects during 2021-22, prior to Ignite.)

WebMD is also integrating into Ignite personalized medication instructions from First Databank (FDB)’s Meducation through WebMD Ignite’s Krames On FHIR platform. It will then go into prescribers’ EHRs and patient portals. FDB release

Dexcom receives FDA clearance for Stelo, the first over-the-counter (OTC) continuous glucose monitor cleared in the US. Like the prescription version, the biosensor attaches to the arm to monitor blood glucose without skin penetration and connects to a Dexcom phone app. The sensor is the same as the prescription Dexcom G7, with a battery life of about 15 days. Stelo was cleared for use by adults 18+ who have Type 2 diabetes but not on insulin therapy–over 25 million people in the US. Release is scheduled for online-only release this summer as a cash-pay purchase (cost not disclosed), with insurance reimbursement TBD over the next few years. Mobihealthnews, Healthcare Dive

Centene may be close to selling its ‘dream’ Charlotte, North Carolina headquarters building. The now near-complete 800,000-square-foot building in Charlotte’s University City would have been Centene’s East Coast HQ. It was planned by the previous CEO in 2020 to be the center of a campus with over 6,000 employees, 3,200 to be hired locally. The plan was abandoned in August 2022 due to a shrinking office-based workforce primarily in St. Louis with some in plan locations throughout the country. Cushman & Wakefield is marketing the building with word being that a single company is interested in purchase. New Class A space is reportedly relatively rare in Charlotte, though the vacancy rate in the immediate area is at 25%. There is also undeveloped land on the site that has attracted interest from a locally active multifamily developer, although that would require a rezoning. Centene purchased the land in 2020 for $19 million, not including a separate 51-acre parcel purchased later in 2020. In addition to reducing its real estate pattern, Centene has also been reducing its staff with two 2,000-person layoffs in 2023, one in the summer and the second in December.  Charlotte Business Journal, Becker’s

Mid-week roundup: Cotiviti’s $10.5B stake to KKR; Cigna buys back $3.2B shares; VA Oracle Cerner faulty med records; LockBit ransomware websites cold-busted at every level, principals indicted; Trualta partners with PointClickCare

February 22, 2024 | by

Investor KKR announced their buy of a $10.5 billion stake in healthcare analytics Cotiviti. The stake comes from Veritas Capital, creating an equal share of ownership. The recapitalization will be used for commercial expansion, new product development, and technology-related opportunities. It is expected to close subject to regulatory approvals in Q2 this year. According to Axios and Bloomberg, it is financed by a $5 billion leveraged loan sale launched last week, with a $4.4 billion floating rate term loan led by JPM and a $600 million fixed rate term loan led by Goldman Sachs. This is Veritas’ second attempt to exit. While money is leaking back into private equity deals, the new trend is to finance them with more cash than debt. Cotiviti release

Cigna, having sold off its Medicare Advantage plans for $3.7 million to HCSC, is repurchasing $3.2 billion in stock (7.6 million shares) through agreements with Deutsche Bank and Bank of America. Cigna’s plan remains to repurchase $5 billion of common stock over H1 2024 after ending merger talks with Humana. FierceHealthcare, Cigna release

VA warned about faulty medication records in the Oracle Cerner Millenium EHR. The culprit is in the Health Data Repository, according to a government watchdog. David Case, deputy inspector general for the VA, reported at a House Veterans Affairs Committee Technology Modernization Subcommittee meeting last week, that while VA had no reports of harmful drug interactions, Case had at least one instance of a veteran not given a critical medication for adrenal insufficiency, leading to a near-disastrous outcome. The VA has also not informed the 250,000 veterans with prescription records in the Oracle Cerner system that the records may have errors.. In the VA facilities that have Oracle Cerner, providers, pharmacists, and frontline staff must perform complex manual medication safety checks to replace automated checks.

The Oracle Cerner rollout has been put on hold till summer this year–maybe [TTA 1 Nov 23]. At this hearing, Mike Sicilia of Oracle did show up and attributed the problems in the HDR to multiple systems being involved from VistA and other EHRs, into Oracle Cerner. However, after 10 separate fixes, the most recent software update had a similar data issue during final testing and was quickly pulled. Military.com

A victory versus ransomware. Updated. The LockBit ransomware group has been cold-busted “at every level” by the UK, US, and international law enforcement. According to the Department of Justice release and other sources, the UK’s National Crime Agency’s (NCA) Cyber Division led Operation Cronos, working in cooperation with the Justice Department, Federal Bureau of Investigation (FBI), and other law enforcement agencies worldwide. They seized numerous public-facing websites and domains used by LockBit to connect to the organization’s infrastructure along with servers used by LockBit administrators. Russian nationals Artur Sungatov and Ivan Kondratyev, also known as Bassterlord, were indicted in the US District Court of New Jersey in Newark, charged with deploying LockBit against numerous victims throughout the United States. Sungatov was also indicted in the Northern District of California. According to Europol, “Two LockBit actors have been arrested in Poland and Ukraine at the request of the French judicial authorities. The French and US judicial authorities have also issued three international arrest warrants and five indictments.” LockBit’s ‘heart’ is of course in Russia, where nearly all cybercrime is located–they are free to operate there as long as they don’t target anything in RU. Cybernews

Trualta partners with PointClickCare for family caregiver education and support. PointClickCare is a leading EHR for long-term and post-acute care (LTPAC) providers. Trualta provides educational resources to support family caregivers when a patient is discharged through logging in to the resource site, with the ability to access articles, videos, and modules that cover a variety of care topics including preparing for discharge, transitioning from hospital to home, and life after discharge.  Trualta’s information will be offered through PointClickCare’s Marketplace. A recent study by Trualta of caregivers using their materials found that 30 days of Trualta use can decrease annual unexpected hospital visits among care recipients by 20%. Trualta release

Mid-week short takes: Ireland’s HealthBeacon bought by Hamilton Beach (!), Ambience AI raises $70M, VA to develop VR mental health app with Mynd Immersive

February 7, 2024 | by

Dublin’s HealthBeacon PLC has been sold to Hamilton Beach Health. HealthBeacon is an app platform/device/injection care management system that integrates with patient support programs to remind them to inject their medications on schedule. Since its formation in 2021, Hamilton Beach Health has marketed the HealthBeacon Smart Sharps Bin in the US. HealthBeacon was founded in 2013, currently has 50 employees and operates in the UK, Europe, North America, and Australia. Acquisition cost was not disclosed, but HealthBeacon’s current investors over 10%, according to their investor page, are Cantor Fitzgerald Ireland Client Nominees Limited, Oyster Capital Investments Limited, James Joyce (CEO), and Canaccord Genuity Wealth Management.

Kieran Daly, a co-founder of HealthBeacon, will run day-to-day operations reporting to Rob George, VP of Hamilton Beach Brands, now Global General Manager. This Editor had surprisingly never heard that Hamilton Beach, associated more with kitchen appliances, had a Health division among the mixers, electric kettles, and garment steamers. Release

Ambience Healthcare raised a healthy $70 million Series B. It was led by Kleiner Perkins and OpenAI Startup Fund. Ambience Healthcare is (naturally) in the hot healthcare AI sector with four applications (soon to be five) described as an ‘operating system’ for the end-to-end patient journey through nearly all specialties and integration with six major EHRs. Current deployments are with UCSF, Memorial Hermann Health System, John Muir Health, The Oncology Institute, GI Alliance, Midi Health, and Eventus WholeHealth. Results claimed are reduction in documentation time by an average of 78%, improvement in coding integrity, and at least a 5X return on investment. Release

VA to develop VR extended reality (XR) mental health app with Mynd Immersive. Mynd’s market has generally been in senior and post-acute care as a digital therapeutic using the HTC Vive VR glasses and programming ranging from speech, cognition, and behavioral therapies to recreation and pleasant distraction. Mynd is used by the VA in 100 long-term care facilities across the country. The new VA/Mynd partnership is targeted to Vietnam veterans to provide them with virtual journeys created specifically for Vietnam veterans via a project titled “Virtual Vietnam: A Path to Peace.” As this generation is now reaching their senior years, old conditions such as PTSD and new ones such as isolation occur, reviving or exacerbating Vietnam War memories. The Virtual Vietnam project is a three-year cooperative research and development agreement. Healthcare IT News, VA/Mynd release  TTA 9 Nov 23 on Mynd’s recent study on effectiveness with Stanford University’s Virtual Human Interaction Lab. 

Short takes: Orion digital pain therapeutic to be commercialized by Newel Health; Verma to head Oracle Health; CVS to shut 25 LA-area MinuteClinics

February 2, 2024 | by

Orion Health licenses its chronic pain therapeutic to Newel Health. Orion’s ODD-533 (Rohkea), classified by FDA and the EU MDR as software as a medical device (MDSW or SaMD) will be developed, manufactured, and commercialized by Newel. Newel, located in Salerno, Italy, designs and commercializes digital medicine and digital therapeutics (DTx) for the US and EU such as Soturi, a digital therapeutic app for Parkinson’s Disease [TTA 23 Feb 23], Orion, located in Espoo, Finland, develops primarily human and animal pharmaceutical products. Orion release

Oracle wastes no time in finding a new Oracle Health head, Seema Verma. Conveniently in-house, the former head of the Center for Medicare and Medicaid Services (CMS) from April 2017 to January 2021 joined Oracle in April last year as senior VP in charge of life sciences.  As executive VP, she will oversee both Oracle Health and life sciences as general manager. Verma’s appointment was announced internally in December, according to Bloomberg. In January, Oracle Health’s general manager, Travis Dalton, announced his departure effective 1 March to join MultiPlan as CEO and president. Verma’s government experience will come in handy, as she has the difficult situation of the stalled Millenium EHR at the VA as well as finalizing the Military Health System rollout, ensuring interoperability–as well as growing the faltering hospital EHR business. By combining the positions, Oracle also eliminates one large C-suite salary. Becker’s

And confirming signs of softness in the clinic business [TTA 24 Jan, JPM’s new reality], CVS announced the closure of 25 MinuteClinics in the Los Angeles area. Closing date is 25 February. They will retain 11 MinuteClinic locations in the Los Angeles area, including an on-demand virtual care practice. Clinics are losing out to virtual care and for more immediate needs, urgent care. This follows Walgreens’ closure of a planned 60 VillageMD adjacent practice locations and softness in their CityMD clinic group. List of 25 closures (LA Times), Becker’s

Short takes: Oracle Cerner still has major hurdles, says VA, Congress; One Medical adds Hackensack Meridian to specialist network, HTA to employer benefits; NHS trialing AI tracking of home behavioral patterns for at-risk patients

November 17, 2023 | by

VA’s All Quiet on the EHR Front doesn’t mean nothing is happening. With the House hard at work with a new speaker, negotiating budget extensions, and generally trying to get work done before the Christmas-New Year recess, the work of subcommittees goes on. Rep. Matt Rosendale (R-Montana), chairman of the House Committee on Veterans’ Affairs’ Subcommittee on Technology Modernization, yesterday (15 Nov) in what was titled “Electronic Health Record Modernization Deep Dive: System Uptime” got an update on the status of Oracle Cerner from Kurt DelBene, the VA’s chief information officer. His testimony wasn’t exactly reassuring. “Overall we still think there’s a ways to go. I don’t want to present the system as all set and ready to go.” In a rare show of bipartisanship, ranking member Rep. Sheila Cherfilus-McCormick, D-Florida, said that “[Oracle] training and change management are still woefully inadequate and user satisfaction is still critically low.” And despite being invited by Chairman Rosendale, Oracle’s Mike Sicilia didn’t show up or send regrets, which made Rep. Cherfilus-McCormick a little livid. FedScoop  HISTalk in its recap also pointed out that Rep.Rosendale “cited a report saying that it will take Oracle Health 15 more years to match VistA’s functionality. [VA deputy CIO Laura Prietula] responded that she doesn’t think it will take that long.” Oracle Cerner, in the few VA locations where it is operative, has not had a complete system outage in six months. Hearing and 1 hour 46 min. video (YouTube), hearing documents

Amazon continues to build out One Medical to, perhaps, ubiquity. On the East Coast, Amazon’s One Medical adds a major New Jersey health system relationship, Hackensack Meridian Health. Like its newly inked relationship with CommonSpirit Health, it will add integrated specialty providers to One Medical’s primary care focus. Specific locations based on patient needs are not specified yet nor financials. Implementation timing is unusually long–by the end of 2024. On a faster track may be One Medical’s deal with Health Transformation Alliance (HTA), a consortium of large US employers comprising 67 employers including Coca-Cola, Intel, Boeing, and many others totaling nearly 5 million employees. Timing and financials were not disclosed. This adds to One Medical’s current contracts with 8,500 companies that offer its primary care services as an employee health benefit. Becker’s, FierceHealthcare

NHS experiments with predictive health indicators and AI modeling for at-risk patients to prevent unnecessary admissions. Four GP practices in Somerset will be using an AI system that will flag registered patients who have complex health needs first, and are most at risk of hospital admission or who rarely contact their GP. Monitored in Buckinghamshire, the most interesting part of this is that the AI is linked to electronic sensors on kettles and fridges that spot changes in Somerset patients’ eating and drinking habits, obviously as an indicator of changes in health. (Does this remind anyone of 3rings or QuietCare?) Changes are reported to an Onward Care team of health coaches, nurses, and GPs who speak to patients and ask about any health or living issues. They can provide, based on patient input, deliveries of food parcels, arranging for cleaning or shopping services, home alterations to help to avoid falls, or to link them up with local voluntary groups to reconnect them with community resources or simply to help avoid loneliness. Clinical care can also be scheduled including specialist care. The NHS reports that GP practices can use this system to solve 95% of their issues or escalate anything clinical. Why this is important: hard winter and isolation, even with the holidays, loom after an autumn of wild weather and the persistent shortage of hospital beds and GP capacity/timeliness of appointments.  DigitalHealth.net

Catching up on Oracle Cerner and the VA, plus the AI ‘tech sprint’

November 1, 2023 | by

Since Congress passed appropriations for the VA in September/October [TTA 3 Aug on House bill] after a busy and acrimonious summer, things have been very, very quiet. The appropriations require multiple mandatories around reporting by Oracle and the VA, which have kept them busy. Prior to this, VA screeched to a halt any further implementations of the Cerner EHR until the five current ones are fixed. The exception–the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully-integrated VA and Department of Defense (Military Health System) healthcare system, with a projected go-live of March 2024.. As MHS, a much smaller and focused system, is just about completed with Cerner and the VA implementation is now postponed, Oracle decided to lay off former Cerner staff in fairly substantial numbers–500 to a rumored 1,200 layoffs in June.

Additional updates:

  • As of a September report on FedScoop, VA and Oracle Cerner plan to resume implementations during the summer of 2024, according to Dr. Neil Evans, acting program executive director of the VA’s EHRM Office, during a House Appropriations Oversight hearing on implementation of the VA’s EHRM initiative with Oracle Cerner that included Oracle’s Mike Sicilia.
  • At that hearing, VA reported that the first round of fixes were completed on the EHR on 31 August in the first round of three-month increments.
  • But during the Appropriations Oversight hearing, leaders of the VA medical facilities already using the Oracle-Cerner EHR testified that productivity is still less than when they were on VistA. Workers are putting in longer hours to cover the workload. Overal, the five the medical centers have hired on extra staff to compensate and have reported “exhausted, sometimes tearful, and frankly distressed” staff in dealing with multiple errors.
    • Robert Fischer, director of the flashpoint Mann-Grandstaff VA medical center in Spokane, Washington, testified that they hired 20% more staff and 15% more clinicians to handle the same workloads. “I would say one of the root causes is related to Oracle-Cerner’s lack of appreciation for the complexity of VA operations,” Fischer said.
    • Since implementation, employees have investigated 1,600 Oracle-Cerner-related patient safety events, 15,000 “break-fix” IT help tickets, and 28,000 medical orders that “did not execute successfully as anticipated.
    • Example: at the VA Ambulatory Care Center in Columbus, Ohio, “Imagine being a doctor in Columbus, and receiving a critical message about a patient you have never seen, who’s been admitted to a Department of Defense site thousands of miles away, because his provider has a similar name,” Meredith Arensman, their chief of staff, testified. “Imagine being an optometrist and finding an eyeglass prescription that has your signature, that you know you never signed … These are not possibilities. It has been the reality.” Federal News Network
  • Perhaps as a backup, the VA inked a deal made public today (31 October) with 13 community hospital systems for data sharing.  The stated intent is by data sharing, they will improve veterans’ care in or outside the VA system, facilitate veterans taking advantage of VA and community resources, and connect veterans with VA benefits, including new benefits for toxic exposure-related conditions under the PACT Act. However, it’s also well known that VA offloads to community health systems. The systems are listed in the VA release. Work has already started and proof-of-concept is due in early 2024. FedScoop

VA also has to cover the now executive-ordered (EO’d) $1 million ‘tech sprint’ for healthcare innovation to 1) reduce staff burnout and 2) create AI-centered tools to save time for clinicians, such as clinicians’ note-taking and integration into veterans’ medical records. This one will consist of two three-month AI Tech Sprint competitions. More distraction. FedScoop

The Cerner blues, VA and health system driven, are affecting the Oracle share price. But Oracle chairman’s Larry Ellison need not worry. His net worth of $130.9 billion makes him the second wealthiest person in healthcare, topped only by Jeff Bezos of Amazon and followed by Thomas Frist and family, according to Forbes. Becker’s

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

August 3, 2023 | by

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.

News roundup: MHS Genesis EHR completes US rollout, telehealth selective savings by disease, CarePredict’s $29M funding, Amazon Alexa *Spying on You*

July 14, 2023 | by

At least one part of Oracle Cerner’s work is done. The Military Health System (MHS), which covers 9.6 million active duty beneficiaries and 205,000 medical providers, announced yesterday that the rollout of the Genesis EHR is complete in the continental US. The final go-live was at Wright-Patterson Air Force Base, which covers 6,800 clinicians and providers in military hospitals and clinics across Ohio, Virginia, Maryland, Indiana, Texas, and Kentucky. It was also deployed at the National Oceanic and Atmospheric Administration, NOAA Corps, which is under the Department of Commerce. The final 14% of the MHS system is overseas. That rollout will start in September 2023, including Landstuhl Regional Medical Center in Germany and Royal Air Force Lakenheath in the UK. Bases in Guam, South Korea, and Japan will follow in October. DOD’s one joint facility with the VA, the James A. Lovell Federal Health Care Center in Chicago, will deploy in March 2024. All other VA healthcare centers are on hold indefinitely. With the wrapup of MHS Genesis and the pause on VA’s Millenium rollout, Oracle has reportedly laid off over 500 staff on these Federal projects [TTA 16 June]. DVIDS release

 Telehealth’s selective savings. A new study out of the University of Texas-Austin McCombs School of Business found, like other studies such as Epic Research’s, that telehealth visits reduced future outpatient visits, in their study within 30 days, by 14%. This saved $239 per patient in outpatient costs. But telehealth was more effective for some specialties than others. It had the most impact on cost reduction for behavioral health, metabolic disorders, dermatology, and musculoskeletal (MSK) disorders, with a significant reduction of 0.21 outpatient visits per quarter (an equivalent cost reduction of $179). This suggested to the researchers a substitution of telehealth versus traditional clinic visits. But telehealth’s impact was nearly nil when it came to circulatory, respiratory, and infectious diseases, not significantly reducing the number of future visits or costs. The study sampled hospital-based outpatient clinics in Maryland from 2012 (not a typo) to 2021. Becker’s, UT News, Informs Pubonline (abstract only)  

Senior living monitoring system CarePredict adds $29 million from four main investors. This is a Series A-3, which one assumes adds on to an existing Series A, which was $9.5 million in 2019. The round was co-led by SV Health Investors’ Medtech Convergence Fund and Aspire Healthtech Partners with existing institutional investors Secocha Ventures and Las Olas Venture Capital plus private family offices and individual investors. CarePredict pioneered a wearable bracelet, the Tempo, that wirelessly tracks residents’ activities of daily living (ADLs) in assisted living (AL), independent living (IL), and continuing care (CCRC) settings. Interpretation of ADLs in a platform can predict changes in health and wellbeing leading to better health and extended residence. CarePredict has expanded its platform reporting with other tracking such as context beacons, visitor and wander management, PinPoint digital contact tracing, and family communication apps. CarePredict release, Mobihealthnews

How much does Amazon have on you? If you are a user of Amazon’s Echo system, you already know that Alexa is always listening to you. What you may not know is that Amazon stores that information in a database, including parts of overheard conversations that have nothing to do with Alexa, since Alexa is always on. Even if you (like your Editor) don’t have an Echo but have a Kindle (unlike your Editor) or use the app residing on most smartphones, Amazon knows what you read, what you flip through, and your start and stop times. The Amazon Sidewalk mesh network, used with Alexa and Ring cameras, extends the reach of your router and shares your network with your neighbors. This is in addition to your shopping and even what you look at. In the context of the rollout of Amazon Clinic pending, delayed to 19 July [TTA 27 June], where Amazon is 1) only an intermediary to providers but 2) demand access to all your PHI and PII before allowing access to them, can we as professionals admit this is a glaring privacy violation and that the FTC is actually right?

Kim Komando, well known for her radio and online shows advising non-techies on tech, has an excellent article on how Amazon is piling up information on us all. This is based on a 2021 Reuters investigation and also contains a link to her interview with the two Reuters reporters. The article also describes how to find out what Amazon has on you. Warning–they don’t make it easy. She also addresses the Amazon clinic issue in a FoxNews article.

Mid-week update: Cano Health CEO finally booted, interim named; further information on Oracle Cerner layoffs

June 21, 2023 | by

Cano Health CEO Marlow Hernandez stepping down, but remains on Cano’s board of directors. It looks like Florida-based value-based primary care provider Cano Health is finally starting to clean up its act. The fallout from the long-delayed shareholder meeting taking place last Thursday (15 June) was that the Cano 3 (resigned directors Barry Sternlicht, Elliot Cooperstone, and Lewis Gold), finally got their way with ousting Hernandez. Mark Kent, who was named chief strategy officer in April, will be taking over as interim CEO while the board performs an external search. No time frame was specified.

Hernandez’s departure was not a surprise since Cano had a miserable Q1, with a $60.6 million net loss versus 2022’s barely-there $100,000. Their adjusted EBITDA was only $5 million, compared to $29.2 million in Q1 2022 [TTA 12 May]. Their new chairman of the board, Sol Trujillo, also has a background in turnarounds.

The Cano 3 own about 35% of the shares and one, Barry Sternlicht, invested at least $50 million in the cracked SPAC’s PIPE. They started to push for change back in April. Today (20 June), they issued a statement approving of Mark Kent’s interim appointment though they were not able to prevent the reelection of directors Alan Muney and Kim Rivera as they urged shareholders to do in a 15 June public statement. 

Despite the ouster, the Cano 3 still have plenty of disagreements with how the company is run, nailing these to the door in their 20 June statement responding to what they called an “Offensive Friday Afternoon “News Dump” Regarding its Leadership Transition”:

  • Per his employment agreement, Hernandez is required to step down as a board director now that he is no longer CEO. “Dr. Hernandez’s employment agreement plainly states that ‘the Executive shall be deemed to have resigned from all officer and board member positions that the Executive holds with the Company or any of its respective subsidiaries and affiliates upon the termination of the Executive’s employment for any reason.” They also cite a “history of insider dealings and fiduciary delinquency.”
  • They demand that directors Angel Morales, Dr. Alan Muney, Kim Rivera, and Solomon Trujillo resign immediately as “Dr. Hernandez’s enablers for far too long”. The board permitted the reelection of directors Muney and Rivera despite 82% of shareholders withholding their votes, citing Cano’s post-meeting statement. 
  • Shareholders now must entrust the selection of a new CEO to a board that is not reflective of the majority of shareholders who have lost over 90% of their share value, and not collaborating with the Cano 3 on reforming the board and a new direction of the company. “In fact, it rejected our Group’s two highly qualified director candidates and a proposal to collaborate on a credible refresh of the Board. We are left to question whether Dr. Hernandez and his boardroom allies are continuing to box us out because they are hiding something nefarious. If not, we urge the Board to immediately align with us on a path forward that includes the addition of our candidates – Guy Sansone and Joe Berardo, Jr. – and other essential changes to leadership and strategy.” Both Sansone and Berardo are very senior executives with long, successful records in leading healthcare services and startups.

(Cano Health shares closed at $1.42 today, a decent bump from their valley last week.) To be continued….  Healthcare Dive

Last Friday, TTA was one of the first to cover the Oracle Cerner layoffs (along with HIStalk) affecting the Cerner Federal teams. This week’s coverage elsewhere confirmed that the layoffs were a minimum of 500 to possibly 1,200, plus rescinded job offers and reduced open positions as this Editor saw from employees posting on the Reddit group. They–in particular, The Register (below), confirmed where this Editor would not go in cause-and-effect–that the layoffs were largely due to VA holding further implementations after multiple failures in the five VA systems where it was implemented between 2020 and 2022. The layoffs were also due to the Department of Defense (DoD) Military Health System (MHS) implementation as largely completed, although not glitch-free. It’s a clear cleanout of what Oracle perceives as a problem. 

Oracle did not respond to these publications’ requests for comments.

The new contract’s focus is to fix these five and implement a sixth (James Lovell in Chicago) which is joint with MHS by 2024. This has to be accomplished before implementation starts in the 160 remaining centers plus satellite medical clinics (CBOCs). VA has much leverage in the five one-year terms and the monetary penalty structure [TTA 18 May]. The pressure to perform for an awakened VA–and Congress–is going to be intense on those remaining, and whomever is shifted over from Oracle. This Editor also noted speculation that Oracle Cerner may start to wash its hands of the just-renewed VA EHR implementation by outsourcing most of it.  The Register, Becker’s, Healthcare Dive   TTA’s coverage of the Cerner/VA implementation here.

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

June 9, 2023 | by

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

Friday roundup: VA Spokane quashes staff cuts; EHR market share ex-US; Epic’s proposed UK HQ expansion; Apple watchOS 10 adds health features; Nox Health on Pear buy; GP2U Telehealth sold

June 9, 2023 | by

VA assures Mann-Grandstaff VA Medical Center staff that they won’t face cuts due to their budget deficit of about $35 million. The Northwest regional network director Teresa Boyd said to staff in a 1 June message that  the hospital had “not been asked to cut current staff or reduce services to Veterans to mitigate any effects of the deficit.” Mann-Grandstaff was The Last Straw for the Oracle Cerner implementation, and problems with the EHR and the loss of productivity (estimated at 18%) contributed significantly to the ongoing deficit. This follows on the earlier center director’s statement that Mann-Grandstaff would face at least a 15% cut to make up the shortfall [TTA 31 May]. The Spokesman-Review story goes on to recap the mound of miseries around the Oracle Cerner rollout as well as the local angle with Senator Patty Murray and Representative Cathy McMorris Rodgers, a Spokane Republican who has called for the VA to scrap the Cerner system, but who also called on VA Secretary Denis McDonough to pledge to use money Congress had already appropriated to prevent cuts to staff or services in Spokane.

Speaking of Oracle Cerner, KLAS’ 8 June report on EHR hospital market share outside of the US has Softway Medical by far the leader. Oracle Cerner has the #3 ranking while Epic, tops in the US, is #10. The top 13 are (by 2022 number of hospital beds):

1. Softway Medical: 17,805
2. Dedalus: 9,436
3. Oracle Cerner: 7,564
4. CompuGroup Medical: 6,039
5. IQVIA: 5,803
6. MV: 4,309
7. Philips: 3,486		8. InterSystems: 2,876
9. System C: 2,706
10. Epic: 2,564
11. ezCaretech: 2,376
12. Maincare Solutions: 2,222
13. Meditech: 2,027

Leading in Europe are Softway Medical, Dedalus, System C, and CGM (not on list), while in Asia/Oceania IQVIA, InterSystems, ezCaretech lead. In Latin America, MV and Philips in Brazil with NTT DATA (not on list) in Argentina. Becker’s

But Epic has plans to expand. One sign: plans to move their UK headquarters staff currently located in several buildings in Bristol to a much larger campus on the outskirts of town in nearby Long Ashton. The campus site is currently pasture fields and the village cricket club. This coincides with plans to develop a ‘garden village’ with 2,500 homes to the south that may include a rail station. The public hearing is 12 June in Long Ashton. Bristol Post

Apple debuted its latest iteration of its Watch, OS10, on Monday at its annual Worldwide Developers Conference, with new mental health, vision health, fitness, and medication tools.

  • Mental health: Mindfulness app logs emotions and daily moods, with a Digital Crown that turns to choose a shape to represent their feelings. The Health app adds depression and anxiety assessments which can be turned into a PDF that can be shared with appropriate health resources. 
  • Vision health: this allows users to track time spent outdoors, which can be good for mental and physical health, but supposedly can create nearsightedness through sun exposure (!). This Editor finds this most curious as most of us myopics were ‘that way’ by age 5 or earlier.
  • Fitness tools: a boon for cyclists with workout reminders, fall detection (unless it’s obvious), and an automatic connection to the person’s iPhone to display heart rate, elevation, race route, custom workouts, and cycling speeds. 
  • Medication: follow-up reminders to log medication sent 30 minutes after the scheduled time

Mobihealthnews, CNET video

Nox Health, which bought $3.9 million of Pear Therapeutics assets [TTA 24 May] spilled a bit to Mobihealthnews on their plans for Somryst, the Pear FDA-cleared insomnia treatment. Nox is already in the sleep health business and has several lines of business around benefits for self-insured employers and payers, plus sleep diagnostics and related technologies targeted to hospitals and health systems including the VA. Nox’s origins are in Iceland and while developing sleep diagnostics from hospital to home got to know Pear while they were developing Somryst. Their CEO also has some thoughts on why Pear got sliced up.

Down Under, GP2U Telehealth is being sold, the second change of ownership in just over two years. The seller is UK-based Doctor Care Anywhere (DCA) Group. Australia’s Connected Medical Solutions, operating as My Emergency Doctor (MED), agreed to buy GP2U for A$3 million (US $2 million): A$500,000 in cash and A$2.5 million in Connected Medical Solutions shares. DCA bought it in September 2021 for A$11 million (US$7.4 million), which is quite a haircut in any currency, but announced that the sale is to reinforce its focus on its core UK market. MED partners for telehealth services with over 40 healthcare services, including ambulances, primary health networks, residential aged care facilities, hospitals, urgent care centers, and multi-purpose centers. DCA’s current UK consults in April/May totaled 121,200, up 30%. Mobihealthnews, MarketWatch

VA renews Oracle Cerner EHR contract, but with multiple caveats, metrics, and annual renegotiations

May 18, 2023 | by

VA finally gets tough with Oracle Cerner–when things are not peachy at the latter. The Oracle Cerner EHR contract with the Department of Veterans Affairs (VA) was renewed with 28 key performance metrics attached to monetary credits. Instead of another five-year term, there are five one-year terms that allow VA to revisit the contract annually. It was not a ringing vote of confidence in the relationship, with good reason, as the EHR implementation has ground embarrassingly to a halt over five years with only five deployments in VA medical centers, of 166 centers plus their medical clinics [TTA 26 Apr, 18 Mar].

The renegotiated contract holds Oracle accountable in four key areas, according to a VA update document obtained by Bloomberg Government:

  1. Reliability: Minimizing outages (time when the system crashes completely), incidents (time when one component of the system isn’t working), and interruptions (time when the system is operating slowly) of the system.
  2. Responsiveness: Quickly and reliably resolving help tickets and clinician requests.
  3. Interoperability with other health care systems: Ensuring that VA can quickly and reliably access patient health records from private sector hospitals when necessary, so we can provide informed, world-class care to those we serve.
  4. Interoperability with other applications: Ensuring that the EHR system interfaces with VA’s website, mobile app, and other critical applications, so Veterans have a seamless and integrated health care experience.

With 28 performance metrics that if not met will result in Oracle paying a monetary credit to the VA, there’s a big monetary incentive for Oracle. For instance, in the VA update document, they claim that Oracle would have paid approximately a 30-fold increase in credits for the system outages, which is only one of the metrics. “The amended contract lays the groundwork for VA and Oracle Cerner to resolve the EHR issues identified by the “assess and address period” and optimize EHR configuration for future sites.” Becker’s, Healthcare IT News

The contract negotiations were a hot button in recent weeks for both the House and Senate veterans’ committees, with multiple bills proposed and hearings. The 9 May hearing by the House Subcommittee on Technology Modernization Oversight (Committee on Veterans’ Affairs) was no love-fest, with chair Matt Rosendale (R-MT) once again concluding that the best thing for the VA would be, as he proposed in his bill H.R. 608, to cut Oracle loose and start over. VA obviously did not agree, being between a rock and a hard place, but this hearing put Oracle’s Mike Sicilia on the hot seat about the EHR’s pharmacy software to support the VA’s role as both prescriber and prescription filler–which he previously committed to having fixed by this past April. Carol Harris, Director, Information Technology and Cybersecurity, Government Accountability Office (GAO), responding to Rep. Rosendale’s questions, described a system that is not fully functioning and puts veterans at risk with failings by both Oracle and VA. In the current state, VA users are extremely dissatisfied. The present workarounds and ad hoc processes outside of the system are not sustainable and are set to fail. She also pointed out that VA needs to set goals for what constitutes user satisfaction with clear and objective measures before future deployments. VA must take a leadership role in change management beyond what Oracle does in the deployment. Hearing on YouTube (2.01:50) Witnesses and support documents

Over at the Senate, the majority and minority patted themselves on the back about the new contract enough to herniate a disc. The majority statement is a press release about chairman Jon Tester (D-MT). The minority statement from Jerry Moran (KS) tartly described the new contract as a “step in the right direction, but fixing the current EHRM program will require a major overhaul” which of course his bill would address.

The added scrutiny comes at a bad time for Oracle Health with turmoil reportedly festering within the Cerner acquisition. Oracle has laid off 3,000 workers, pausing raises and promotions. 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. Cerner’s signature buildings in Kansas City are being sold and emptied. If Mr. Ellison wants to transform healthcare, he needs to start at home, rebuilding Cerner-Oracle Health rather than decimating it, and fixing VA as Job #1. Business Insider

Additional recent coverage: 28 April, 20 April, 19 April, 31 March

VA completely halts Oracle Cerner EHR implementation for ‘reset’; House introduces new–fourth–bipartisan reform bill–and another outage

April 26, 2023 | by

The Department of Veterans Affairs (VA) pulls on the parking brake for Oracle Cerner, but doesn’t turn off the engine. Last Friday (21 April), the VA formally announced ) that it would cease further deployments of the Oracle Cerner EHR until they can “prioritize improvements at the five sites that currently use the new EHR, as part of a larger program reset.” They have pledged to fix the issues that were identified during the “assess and address” review that started in late summer and fall 2022. No date was given on a restart which would come after which is presumably the ‘address’ part of the process.

In the release, VA will be redirecting resources to “focus on optimizing” Oracle Cerner where it is currently rolled out: Spokane VA Health Care System (Mann-Grandstaff), VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care, and VA Central Ohio Health Care System. The only exception is the deployment at the Captain James A. Lovell Federal Health Care Center in Chicago – which is the only fully-integrated VA and Department of Defense (Military Health System) healthcare system. That will proceed with a go-live of March 2024.

FedScoop reported that in a live briefing call with reporters, Dr. Neil Evans, who is the acting program executive director for the EHR Modernization (EHRM) Integration Office, would not give specific details about the contract negotiations with Oracle Cerner. “The original contract was a five-year base period with a five-year option, but everything has been on the table as part of the contract negotiations. I anticipate we’ll be able to share more as we near the end of those negotiations.” and “We are working towards an amended contract that will hold Oracle Cerner accountable to delivering the high-functioning, high-reliability EHR system that veterans deserve and will lay the groundwork for our expectations around improvements to the system that we think are necessary.”

The release also revealed a little surprise: “VA estimates FY 2023 costs will be reduced by $400 million.” This Editor noted last week that the March Senate VA Committee disclosed that the VA paid Oracle Cerner $4.4 billion on the contract to date, with a refund of $325,000 paid as compensation for ‘incomplete technology and poor training’. Obligations through the contract were $9.4 billion. The VA will be working with Congress on resource requirements.

Speaking of Congress, the House has now proposed a fourth bill, H.R. 2809, requiring the VA to reform the EHRM program. This bill takes the ‘hold rollout till issues’ position versus “pull the plug” (H.R. 608, which hasn’t moved out of subcommittee). This would require:

  • establishment of program management within the Veterans Health Administration
  • reorganizing the management of the current reporting structure for the EHR functional champion and deputy CIO
  • restricting the monetization or selling of veterans’ data by any internal or external entity conducting work for the VA
  • requiring that performance baselines are met or exceeded at the five live sites before it goes live in other systems

Unlike the VA release, there’s a time limit and a kicker. 180 days after legislation enactment, if VA and Oracle Cerner cannot meet the requirements for the five sites, the bill directs VA to consider terminating or canceling the contract. ‘Consider’ is a bit of a weasel word, but is probably as far as the House wants to go. Another difference is that it is bipartisan, proposed by Democrat Mike Takano of California with six other Democrat House members but with the co-sponsorship of three Republicans, including Rep. Mike Bost of Illinois who is the chairman of the House Committee on Veterans’ Affairs which will review the bill.  TTA’s most recent coverage of VA’s troubles with Oracle Cerner: 19 April, 20 April

And yet another outage. On 25 April, the Oracle Cerner EHR was unusable for at least five hours. It affected Spokane, Wash.-based Mann-Grandstaff VA Medical Center, Fairchild Air Force Base, and military hospitals across the country, which means it affected VA and MHS where it has largely replaced AHLTA. The Spokane Spokesman-Review obtained an email from Mann-Grandstaff Director Robert Fischer confirming the outage Tuesday while it was happening. Dr. Feinberg, the Cerner integration is going great, right? Fixing this should be Job#1.  Becker’s HealthIT

VA, GAO push back against proposed House overhaul measures

April 20, 2023 | by

Today’s House Veterans’ Affairs Subcommittee on Oversight and Investigations meeting didn’t bode well for House bills demanding reform or restart. The Democrat-backed bill, dubbed the Manage VA Act, and the second Republican bill, Terminate VA’s EHRM Program (there is also a third, proposed by Republicans, the Electronic Health Record Modernization Improvement Act) were criticized by both VA and GAO representatives at the meeting.

The Manage VA Act proposes the creation of a VA undersecretary for management, who would serve as the Chief Management Officer (CMO). This would not only be for the Oracle Cerner EHR Modernization (EHRM) but also consolidate and standardize acquisition and IT functions across VA. VA and GAO criticized the new position as duplicative of the current VA structure and would run into obstacles similar to a CMO effort within the Department of Defense (DOD), such as lack of clarity and conflict with the CIO plus lack of funding for cross-functional teams and initiatives proposed by the CMO. To FedScoop, Shelby Oakley of the GAO representative expressed a dim view of how the VA has been handling things. “There needs to be much more discipline in the VA’s EHRM approach right now and it’s not clear that the CMO position would change that.” 

The Terminate VA EHRM Program bill, not unexpectedly, was derided as impractical and impossible. Fact: VistA is 40 years old and previous upgrade attempts have failed. Yet a VA deputy CIO just a month ago at an industry meeting, the Association for Federal IRM (AFFIRM), admitted that VistA is being moved to the cloud and being ‘containerized.’ Another VA software executive said it may be needed for another 10 years. You have to wonder if the House or Senate VA committees even know this and appreciate what it really is saying.