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July 15, 2021 News 10 Comments

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VA Secretary Denis McDonough tells the Senate Veterans’ Affairs Committee that he is putting the VA’s Cerner implementation on hold. This follows completion of a three-month project review that found serious “governance and management challenges.”

McDonough says that the VA’s first implementation at Mann-Grandstaff VA Medical Center (WA) in October 2020 did not live up to its promise of “seamless excellence in VA care,” adding that the report found “numerous patient safety concerns and system errors” as well as significant negative impact on productivity.

McDonough said he commissioned the review after hearing firsthand about duplicated prescriptions at Mann-Grandstaff and a user’s complaint that a Cerner help desk employee was unable to answer a user’s questions because he had just one week’s experience. He added that clinicians tell him that most of the integration between the respective Cerner systems of the VA and DoD happens inside their heads, not on their computers.

McDonough vowed to improve training and testing, to increase its oversight of Cerner, and to make leadership changes to get the project back on track. He also says the original plan to roll out Cerner by geographic area was a mistake and scheduling of go-lives will now be based on evidence of readiness.

The cost of the project, which was originally estimated at $10 billion when Cerner was awarded a no-bid contract in 2017, has risen to over $20 billion. McDonough has ordered a new budget estimate for the entire project, which will include the several billion dollars of infrastructure upgrades that the original estimate missed.

Committee chair Senator Jon Tester (D-MT) told the group, “I’ve had the impression for some time there are folks out there milking the cow. Every day they go out and they see this cash cow, and they’re getting every dime they can get out of it. There’s been damn little accountability. I hope Cerner’s watching this. Cerner’s not up to making a user-friendly electronic medical record, and in fact what’s transpired here is we’re going in the opposite direction, then they ought to admit it and give us the money back so we can start over.”

McDonough identified specific project issues:

  • The VA lacks a specific definition of a patient safety issue and how to manage open issues.
  • The decrease in productivity includes problems in revenue cycle, where much of the claims and payments process requires manual entry.
  • Cost estimates did not include any issues beyond the Cerner contract, infrastructure readiness, and the project management offices.
  • The VA did not create key performance indicators.
  • The patient portal experience was fragmented, leading the VA to study the user experience to support “decisions on the future of the portal” that takes legal and contractual obligations into account.
  • Testing did not reflect real-world workflow.

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Also offering testimony to the committee was Ellkay Chief Innovation Officer Marc Probst, MBA, who described the rollout of Cerner at Intermountain Healthcare when he was CIO and the keys to a successful EHR implementation. He responded to a question about what Congress should expect by urging clear goals, reductions in support tickets and complaints over time, and performance against real milestones. Asked if anything stood out for immediate action, Probst recommendation resetting expectations against original and current requirements and reviewing detailed project work plan milestones.


Reader Comments

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From Rashaverak: “Re: Woman’s Hospital, Baton Rouge. This is the first I’ve heard that the sheer cost of an EHR implementation is driving a hospital’s business strategy, essentially forcing it into an affiliation or merger because it can’t afford its EHR of choice. It must be a record for Epic if the hospital’s stated cost is indeed $200 million over seven years – has Epic no shame for pricing the system at 10% of the 168-bed hospital’s total expense? That kind of pricing will keep Meditech and Allscripts around and makes the $1.2 billion that Partners spent over 10 years look like a bargain. Isn’t the goal of IT to bend the cost downward instead of upward?”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor VitalTech. The Plano, TX-based company offers more than telehealth. More than RPM. More than population health. VitalTech is the nation’s first fully integrated virtual care platform. The company develops technologies, platforms, and hardware that empower patients to better care for their health and wellness while enabling clinicians and health systems to remotely monitor, manage, and care for patients. Its integrated digital health platform, VitalCare, aggregates and contextualizes critical data that is collected from multiple devices, EHRs, and third-party sources. Data is then pushed via the VitalCare cloud to user apps, family connection apps, care teams apps, administrative web portals, and third-party integrations in real time so actionable insights can be made. The solution enables health systems, physicians, payers, employers, senior living facilities, skilled nursing facilities, and home health providers to streamline workflows while improving health outcomes, increasing patient safety, and lowering the cost of care. The suite includes easy-to-use devices and software that increase patient engagement and compliance. Thanks to VitalTech for supporting HIStalk.

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VitalTech sent over a link to this intro video and client testimonial. Holy Name Medical Center CEO Michael Maron movingly describes how contracting COVID-19 and then infecting his own family was a “burden I’ll have to bear for the rest of my life,” but he says that being monitored by VitalTech’s system at least allowed them to recover at home.


Listening: old Genesis, which I didn’t follow until pandemic times. “Firth of Fifth” and “Supper’s Ready” are as good as music gets to my ear, and while I can’t abide the treacly 1980s hits of Phil Collins, he spent the late 1970s effortlessly backing and then leading a band of individual musical geniuses by drumming the most complex time signatures imaginable. Genesis wrote and played their best music, which I predict will be as timeless as Beethoven, in their late teens and early 20s.

I’m jealous of people starting new jobs who post photos on LinkedIn of the cool company swag that was waiting at their desk on their first office day. I don’t think I ever got anything when I took a new health system job.

It’s about time to post my HIMSS21 guide describing what HIStalk sponsors will be doing there, so submit your information this week. I’ve received submissions from 19 companies, including two who aren’t actually sponsors and thus will be regretfully unrepresented.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Healthcare payments software vendor Waystar will acquire Patientco, whose technology includes patient payments, communications, and engagement.

Bloomberg reports that the private equity owner of healthcare payments analytics vendor Cotiviti is considering an IPO that would value the company at $15 billion.


Sales

  • MedStar Health chooses oncology data and analytics vendor COTA to support cancer research and care.
  • An unnamed drug company will use OptimizeRx’s platform to offer physicians choices when their Medicare patients risk treatment lapse due to loss of coverage.
  • Blessing Hospital (IL) selects CarePort Interop to allow it to meet CMS event notification requirements.

People

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Frank Nydam, MBA (VMware) joins Tausight as chief development officer.

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Glytec hires Scott Bettner, MS (Hillrom) as regional VP. 


Announcements and Implementations

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Non-invasive digital sensor developer Rockley Photonics announces plans for trials of “clinic on the wrist,” a combination of hardware, firmware, and cloud analytics that measures biomarkers such as body temperature, blood pressure, hydration levels, and measures of blood alcohol, lactate and glucose. The company hopes to complete testing and release the product for commercial use next year. The company is about to go public via a SPAC merger.

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Amazon announces AWS for Health, a set of services and partner solutions for healthcare, genomics, and biopharma.

Applied behavior analysis EHR vendor CentralReach acquires Behavior Analysts, Inc., which offers an ABA assessment system.

Amazon Web Services selects Diameter Health as a Connecter Partner for Amazon HealthLake.

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OSF HealthCare opens its OSF OnCall Digital Health building at its headquarters in Peoria, IL. Capabilities of the “virtual hospital” include remote patient monitoring, fall prevent innovations, virtual nurse triaging, ICU monitoring, and monitoring 40 telehealth carts.

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A KLAS report on cardiology systems says that no individual offering stands out, as organizations have pieced together multiple systems but are re-evaluating as part of their enterprising imaging strategy. Most often considered are Philips, IBM Watson Health, and Fujifilm, while Epic is often chosen as part of its product suite even though it lacks a cardiology archive and offers weak structured reporting.


Government and Politics

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ONC hopes to have the Trusted Exchange Framework and Common Agreement (TEFCA) network open for participation in the first quarter of 2022.

The companies contracted by ONC to develop draft EHR Reporting Program developer measures seek feedback by September 14, 2021.


Other

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In Ireland, people complain that their names are misspelled on their government-issued COVID-19 digital travel certificates and worry that the mismatch will prevent them from boarding flights, which the government says is due to hospital, doctor, and pharmacy systems that can’t handle language-specific punctuation and characters such as the fada.


Sponsor Updates

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Contacts

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Currently there are "10 comments" on this Article:

  1. Rashaverak – if one has not seen the total cost projection, it is really anyone’s guess what was included. For example, they may have included changes to the physical facility for the location of charging stations, devices, printers, and the like. They may have included a lot of related but non-Epic software like document imaging, interface engine (new or upgrade), claims clearinghouse, claims editor, clinical content subscriptions, analytics software, and tools to manage the hardware environment. I have seen total costs that add another stand-by data center. Epic knows their product and services pricing. They are a fraction of a typical total cost.

    • Re: “Isn’t the goal of IT to bend the cost downward instead of upward?”

      While this is often a goal, I think it’s somewhat dangerous to assume this in every single instance. Personally, I’ve long said that these EMR/EHR implementations? They often raise expectations of what can be accomplished. And those raised expectations sometimes increase rather than decrease costs.

      Expectations are a matter of politics. Thus, regardless of what the budget said, you may find expenditures beyond the budget. It only takes a sufficiently highly placed executive to demand that their expectations be met.

      That said, I do agree that there are too many instances of cost overruns.

      Having said THAT, know this. There is an extensive body of knowledge concerning IT project work. Large IT systems implementations fail at a greater rate than smaller systems efforts (I’m including both “challenged” and “failed” in this statement). This is industry independent and includes all industrial sectors. Thus it is a mistake to think of this as a unique clinical problem, or something specific to any product or vendor.

  2. Is the Cerner/VA brouhaha much ado about nothing?
    Time and again have seen enterprise system roll-outs run into delays, cost overruns etc which can be particularly painful when you are doing a complete rip n’replace as is the case at VA/DoD. And then there is the whole issue of “lost productivity”. What else is new, study after study has shown that most health systems suffer a min 30% productivity hit for 6-12 months post install.

    This is all not to say that Cerner may be at fault for some issues, eg poorly trained help staff and that the VA didn’t fully account for some of the challenges they would face in this roll-out, but let us not get too carried away with the blame game.

    And note, do believe it wise on the VA’s part to hit the pause button, reassess roll-out plans, define those KPIs and then move forward.

    • Large scale project PM’ing 101 – Never, ever put the Software Vendor in as the Prime on any large contract. Especially when it involves large scale Systems Integration with all kinds of third parties. At least VA is seeming to acknowledge that end goal Requirements are a moving target and the lack of Governance and Accountability.

    • Clearly there was only 1 vendor in the market that even had a chance of delivering on time and on budget, and that’s not who DHMSM chose.

      • There’s also only one vendor that can deliver basic interop out of the box with very little effort, and even richer interoperability with a some terminology mapping. Kind of sad that this project is doing so poorly in this area when that is allegedly why Cerner won out.

    • I believe that Cerner at Intermountain Healthcare was considered a success, no? It is my impression and assumption that Marc Probst was brought in to testify, as a positive example.

      Yet I’m going on pretty thin evidence. I don’t recall any big scandals from Intermountain over their Cerner implementation.

  3. Genesis fan-boy here .. Add ‘Cinema Show’ to your list as well. “Selling England By The Pound’ is my favorite ‘old’ Genesis album

  4. Bleargh! Genesis was terrible while they were headed up by Peter Gabriel. Both Genesis and Peter Gabriel got much better after they went their separate ways.

    The issue isn’t Prog Rock either. I like plenty of Prog Rock.

    Some people simply don’t like commercial music. OK, why? Are you responding to your stylistic tastes, or are you seeking the status that can be found by following niche bands?

    That’s not me. I either like some music, or a band, or I don’t. How others respond to it doesn’t affect me at all. Nor do I care much about how commercial that music is.







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