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Monday Morning Update 7/11/22

July 10, 2022 News 9 Comments

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An Oracle EVP says in a letter to two members of of VA’s Subcommittee on Technology Modernization that the VA’s Cerner system was “not operating as intended” at Mann-Grandstaff Medical Center, in which an “unknown queue” problem caused patient orders to be delayed or lost.

The company says Oracle’s expertise and technology will be used to “rethink approaches not possible before the acquisition.”

Cerner and the VA had agreed on how the queue would be used to detect incorrectly entered orders going back to January 2020, but the VA didn’t train its clinicians to monitor it.

The letter was signed by Oracle EVP and company lobbyist Ken Glueck.

This is good reporting from Orion Donovan-Smith of the Spokane Spokesman-Review.

Meanwhile, Oracle is reportedly considering cost reductions of up to $1 billion that would result in the layoff of thousands of employees as early as next month. Its recent $28 billion acquisition of Cerner added 28,000 employees to Oracle’s headcount of 143,000.

Reader Comments

From Promo Copy: “Re: remote work. Trading tomorrow’s job opportunities for today’s convenience.” I agree that you want to be a familiar company presence when career-advancing plum assignments, promotions, and cross-training opportunities are handed out. Folks who want those things – exceptions being those who mostly travel to customer sites, who aren’t looking to move up, or who work for a company whose executives are also working remotely – might want to watch how those opportunities are doled out based on where the recipient sits. Companies are fans of remote work when they can spend less for office space, pay non-metro salaries in some cases, and get longer workdays for free, but I would be slightly concerned that — other than the atypical use case of superstar Silicon Valley software engineers — executives might then extend the successful proof of concept to workers who are much further away and much cheaper. I also think that companies that skip the hybrid model and allow some but not all employees to work offsite permanently will either reel it back in or inadvertently create two classes of employees who benefit in different ways, which is perfectly fine as long as employees understand their career path options.

HIStalk Announcements and Requests


Poll respondents don’t see a lot of clinician time being wasted doing lower-level work, which is a better result than I expected.

New poll to your right or here, related to the above discussion: Where are the C-level executives of your employer routinely working, other than when traveling? It occurs to me that maybe most employees don’t even know where the suits sit.

Thanks to these companies that recently supported HIStalk. Click a logo for more information.



July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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

Acquisitions, Funding, Business, and Stock


Cardinal Health acquires ScalaMed, whose app is used by patients to receive their electronic prescriptions on their phone, giving them the ability to price-shop and choose their pharmacy after the fact. I like this a lot since I’ve long maintained that e-prescribing forces patients to choose a pharmacy upfront without knowing cost or availability details, then wastes their time (and that of their prescriber) in trying to move the prescription to a different pharmacy.


  • Canada’s Niagara Health chooses Sectra’s radiology, cardiology, and VNA systems.



Deana Rhoades, MBA (NTT Data) joins ZeOmega as VP of business development and channels.


Jill Jemison, MBA (University of Vermont) joins the University of North Carolina medical school as associate dean/CIO.


Ontario Clinical Imaging Network names Shafique Shamji (The Ottawa Hospital) as president and CEO.


Logan Health (MT) hires Steve Garske, PhD, MBA (Pipeline Health System) as CIO.

Announcements and Implementations

Astria Health and Cerner settle their legal dispute in which the health system blamed its 2019 bankruptcy on problems with Cerner’s billing system. Cerner disputed that claim, saying that Astria poorly managed its merger with two other hospitals.


A new KLAS report in PACS in Europe finds that Agfa, Philips, Sectra, and Visus have broad footprints and are growing, with Philips and Sectra having the largest number of high-volume customers.

Government and Politics

Public health experts say that the US is repeating its same COVID-19 mistakes with monkeypox, which should be easy to eliminate because it’s a known pathogen that spreads poorly and had tests and vaccines available before the outbreak began in May. Tests are hard to obtain, vaccines will be in short supply for months, surveillance and contact tracing are poor, and official case counts are are lower than actual. Doctors who see suspected cases must obtain approval from state epidemiologists to send patient samples to CDC, which then takes several days to run the tests and approve the diagnosis.


State-run hospitals in Maharashtra, India report “chaos” as the state unexpectedly and permanently shuts down its Hospital Management and Information System in a dispute with the outsourced service provider. Officials say the contractor refused to pay penalties for poor system performance, so its contract was terminated, after which the vendor refused to provide copies of the hospital data. Those officials added that a new system is ready to install once upgrades are applied.

A Columbus TV station profiles an Epic ASAP analyst who is one of 637 employees OhioHealth is laying off as it outsources IT work to Accenture and RCM to AGS Health. Of the 637 eliminated jobs, 567 are in IT. OhioHealth says that eliminating jobs and hiring “technology and global talent pool external providers” will improve patient care.

A KHN report says that a shortage of mental health therapists is sending patients to online therapy companies, many of them backed by venture capital firms who advertise directly to consumers, whose questionable practices may include using texting with no guarantee of immediate response instead of real-time communication. One company pays therapists per word of text that they write or read. Those companies pay less and thus attract less-experienced providers who are not trained to deliver safe and effective care online. The founder of the Telebehavioral Health Institute questions whether parents should trust an online therapist to treat depression and anxiety in their children, concluding, “”What’s happening is a corporate takeover of behavioral healthcare by digital entrepreneurs.”


Consulting firm president Fred Goldstein tweeted the result of his hour-long wait for a virtual visit from Amwell. I’ve had similar experiences with ride-sharing services, where my assigned driver decided that my fare wasn’t worth their time and cancelled, but you would think telehealth providers would have a way to reassign the visit to another doctor. Interesting to me is that the doctor who cancelled is the chief product officer and medical director of Grapefruit Health, which offers telehealth services to schools. Still, I blame the company’s platform more than the doctor, who may have had a personal emergency that would have created the same result for an in-office visit. It happened to me once – I showed up for a scheduled doctor visit, appeased the clipboard gods with a solid 10 minutes of handwriting (this was my second visit to this single-doctor practice), waited for maybe 20 minutes past my scheduled time, then was called up by the customer-indifferent front desk person to be told that the doctor had the whole day off. I complained and was indignantly told that someone had mistyped my phone number and they couldn’t each me, which of course failed to explain why they checked me in and let me sit there. The doctor, who was much better at medicine than business, apologized afterward and suggested that I call after hours to avoid her incompetent employees

Sponsor Updates

  • Symplr forms an executive customer council to drive its vision for strategic healthcare operations.
  • Net Health adds Pressure Injury Deterioration Risk indicator into its Tissue Analytics AI-powered wound imaging and analysis solution, and a Missed Visit Prediction indicator to its Wound Care EHR.
  • OneMedNet appoints Christoph Zindel, MD to its board.
  • Arrive Health publishes a new customer success story featuring UCHealth, “Arrive Health Helps Doctors Cut Prescription Costs for Patients.”
  • Spok announces that Asia Pacific value-added distributor InTechnology Distribution will offer Spok products and services.
  • Talkdesk wins Cloud-Based CX Solution of the Year at the 2022 Customer Contact Week Excellence Awards.
  • TigerConnect introduces draft mode for physician scheduling.
  • West Monroe Innovation Fellow Doug Laney publishes a new book, “Data Juice,” about the 101 ways business leaders can monetize their data.
  • Wolters Kluwer Health has expanded Ovid with SRI International’s BioCyc collection of organism-centric Pathway/Genome Databases and bioinformatics software tools.
  • Zynx Health and the Hendrich Fall Program form a joint alliance that enables providers to access comprehensive and holistic fall prevention care guidance.

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Currently there are "9 comments" on this Article:

  1. It will be interesting to see in the years ahead if just showing up will be one of the best things you can do to advance your career.

  2. It is hard to imagine that the actual existence of an “unknown queue” for orders is anything else but a bug. Trying to pretend that it as a feature, and then blame the VA for not training physicians to manage “lost” orders does not instill any confidence that this project is going in the right direction…

    • On the other hand, we have the response of the Oracle EVP who claims to have all the solutions without any apparent experience with electronic records. As someone who uses Cerner on a daily basis,I’m well aware of its weaknesses. But the level of arrogance and bravado on the part of the EVP is frightening. Combined with the reputed cuts in staff, which will presumably hit Cerner employees hard, the future for “Oracle Cerner” seems rather dismal.

    • This is a known opportunity for improvement in Cerner’s Millennium Architecture. They do train individuals to watch the ‘unknown orders’ queue. From my experience, this occurs when the locations ‘master file’ is changed and system users have old locations saved as part of their favorites. In theory, the good old relational database cascading update could be used with a database trigger. Those database features tend to be ‘costly’ and impact performance. I do not remember if this also occurs with ‘future orders’ placed before the location was updated and with the orders to scheduling link when a schedule changes or the scheduled event is cancelled.

      • My organization had an issue with the Return to Clinic Order and they were getting routed to the “Unknown Queue”. It was discovered that the providers were adding this order for patients to return on visits(appointment types) that were not set up to “flex” on routing it to the correct work queue. Since I had the pain-staking task of fixing this, it involved re-training and adding the RTC order to those appt types that were additionally needed. To date, this has so far been resolved.

        If is frustrating and it happened for 4 years until we could get to the route of this issue.

      • This is so sad. I had to check that the calendar still shows 2022, and we are not discussing this in 1998…

  3. Re: Cardinal Health acquires ScalaMed
    This app is a great idea and would possibly answer an issue I’ve long been frustrated with. It is pretty much impossible to price shop Rx meds right now due to the cumbersome process that the doctor’s office and pharmacies (not to mention me!) have to go through. Not exactly sure how ScalaMed will work but love the concept! Will keep an eye on them!

    • I did a little work with Scalamed a few years back. At that stage it was an Rx on your phone that you could move or send yourself. Getting around the idea of “send my Rx to this or that pharmacy”. So for example if you want to use GoodRx you can have the Rx on your phone, look up where the best deal is and then send the Rx to that pharmacy yourself. Not sure how the product has evolved in last 2-3 years, but I imagine Cardinal will bundle it into its provider pharmacy services

  4. I would have serious doubts about the accuracy of the poll on clinician work. I would sincerely hope that physicians and others aren’t forcing the poor patient to sit there while we are arguing with managed care companies for pre-auths, dealing with data entry and phone calls that could easily be handled by someone else and the whole host of bureaucratic baloney that is contributing to clinicians’ burnout and leaving the field.

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  1. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

  2. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

  3. Dr Jayne is noticing one of the more egregious but trivial instance of bad behavior by allegedly non-profit organizations. I…

  4. To expand on this a bit. The Vista data are unique to Vista, there are 16(?) different VISN (grouped systems)…

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