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…)

VA distributing iPads to Family Caregivers (US)

July 20, 2013 | by

Back in May 2012 we noted a Veterans Affairs (VA) program for 2013 that would distribute 1,000 iPads to primary caregivers of seriously wounded veterans to facilitate care delivery and data transfer. Then called ‘Clinic-In-Hand’, it is now officially debuting as the Family Caregiver Pilot for caregivers of seriously injured post-9/11 veterans already enrolled in VA’s Family Caregiver Program. The intent is now more clearly focused on reducing caregiver stress, via  pre-loaded apps to share health information, coach patients through chronic pain and PTSD and serve up tools such as reminders and a health journal. A second, the Veteran Appointment Request Web App Pilot, facilitates appointment setting via mobile or desktop PCs for a separate test group of 600 veterans and was launched at the Washington, D.C. VA Medical Center and VA Palo Alto (California) Health Care System. According to EHR Intelligence, if successful it will be rolled out to all patients at these two VA centers with a system rollout in the future–complicated by the fact that every VA center has a different scheduling system. Meanwhile, VA’s VistA and the DOD’s AHLTA still don’t talk to each other. VA integrates mHealth into daily care, gives iPads to vets (EHR Intelligence); VA Mobile Health release (for additional details go to the left hand drop-down menu). Hat tip to Contributing Editor Charles Lowe.

3millionlives and the EHR moneysuck (UK and US)

July 11, 2013 | by | 2 Comments

When editor Donna passed an item from iHealthBeat to me, her comment was “Just as the DOD and VA are fighting over systems, maybe VA can make a few pounds selling VistA to the NHS!” Well, it’s much more interesting than that!

The iHealthBeat item is about a £285,000 ($430,000) exchange programme – of “leaders, staff and ideas” – to see what people from NHS England and the Veterans Health Administration (VA) could learn from each other about digital records and technologies. (This follows the scandalously expensive collapse in 2011 of the NHS’s attempt to develop its own national electronic record system.) Digging around some more, we discover from an item by eHealthInsider that the exchange programme began as part of the 3millionlives (3ML) initiative to compare notes on telehealth monitoring. With 3ML now being incorporated into NHS England, we find that the extended remit of the exchange programme has relegated telehealth to what many seem regard as its proper place in the scheme of things – the sidelines.

VA networks breached from overseas; 20 million records affected (US)

June 19, 2013 | by

Department of Veterans Affairs IT systems have been breached since 2010 by eight ‘nation-state-sponsored organizations’, affecting records of 20 million veterans, according to recent testimony in hearings held earlier this month by the House Veterans Affairs Oversight and Investigations Subcommittee. While the normal ‘hack’ is due to theft or an inside job for financial gain, these likely have a far more sinister nature. According to former VA Chief Information Security Officer Jerry Davis (now at NASA), the attacks continue from these countries, and according to Subcommittee Chairman Rep. Coffman, may include China and Russia. Testimony and evidence also revealed that those responsible for informing Secretary Shinseki may have understated the problem. The VA has certainly been taking its lumps with a Magic 8 Ball of late, with a derailed joint EHR project with the Department of Defense and wrangling on who’s leading integration [TTA 3 April; iHealthBeat]. VA Systems Hacked From Abroad, Was VA Secretary Misled About Breaches? (HealthcareInfoSecurity)

DOD, VA stuck behind the Magic 8 Ball: report (US)

April 3, 2013 | by

Institute of Medicine, ‘Daily Show’ rap DOD, VA for unlinked EHRs

When the US Department of Defense (DOD) and Veterans Affairs (VA) announced back on 27 February that they would not achieve their major goal since 2009 of a single EHR system by 2017, with initial test next year, for this Editor it was just another billion-dollar ‘fail’ day out of DC. FDA dithers since July 2011 on final guidance on mHealth approval–yawn. Centers for Medicare and Medicare Services (CMS) cutting back rural telemedicine consults–business as usual. Individual health insurance premiums going up 30 percent next year? We knew that was coming! So no surprise here when the Institute for Medicine of the National Academy of Sciences issued a report highly critical of both agencies regarding the needs of 2.2 million Iraq and Afghanistan veterans, with one key criticism the lack of EHR interoperability. According to iHealthBeat:

The IOM report found that:
• 49% of returning veterans have experienced post-traumatic stress;
• 48% have dealt with the “strains on family life;”
• 44% have experienced readjustment difficulties; and
• 32% have felt “an occasional loss of interest in daily activities.”
According to IOM, the federal government’s response to troops returning to the U.S. “has been slow and has not matched the magnitude of this population’s requirements as many cope with a complex set of health, economic and other challenges.”

Neil Versel in his Meaningful HIT News article published yesterday highlighted the EHR single-system fail through, rather incredibly, a Jon Stewart Daily Show video segment called ‘Red, White and Screwed’. (Today, in American life, you know an issue has gone mainstream when it makes a ‘news/comedy’ show such as this or the Colbert Report.) This Editor is no fan for multiple reasons, but to his credit Mr. Stewart has been a strong advocate on behalf of veterans and showcases the failure of veterans’ support regularly on a segment called ‘The Red Tape Diaries’ without sparing a certain Administration from criticism.  Aside from over 900,000 veterans waiting an average of 273 days for their disability claims to be processed, the icing on the cake is how the EHR ‘fail’ was announced. At 3:20 in the video, a Government Accountability Office (GAO) official drily depicts both DOD and VA as perpetrators of project mismanagement and poor oversight. And this is despite a 40 percent increase in budget from the Republican-controlled House, which confounded Mr. Stewart. The criticism goes on from there. Magic 8 Ball says ‘messed up, try again.’  DoD-VA integration failure is no laughing matter, even to Stewart  Hat tip to reader Ellen Fink-Samnick, MSW of ‘Ellen’s Ethical Lens’ for featuring this article on her LinkedIn group. 

Related, ironic note: the DOD’s and VA’s EHRs are respectively called AHLTA and VistA, a nostalgic touch for those of us who used the first real search engine, AltaVista, circa 1996.

VA losing CIO, CTO (US)

February 21, 2013 | by

The US Department of Veterans Affairs (VA) has two critical vacancies, just announced: CIO Roger Baker and CTO Peter Levin are both leaving the agency after three years. Their resignations come in the midst of major initiatives: Levin’s ‘Blue Button’ PHR (personal health record), mobile telehealth technologies for suicide prevention and oncology; Baker’s adoption of mobile devices and streamlined claims processes. The VA is also coping with the thousands of Iraq and Afghanistan veterans flooding into the system requiring high levels of care, as well as aging  veterans of the Korean, Vietnam and Gulf (I) Wars. No word in this article on what will come next from either Baker or Levin, or the VA, which is unusual. Healthcare IT News