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September 14, 2023 News 3 Comments

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The VA tells the House Appropriations Committee that it hopes to resume its Oracle Health implementations in the summer of 2024.

Go-live at the joint VA-DoD facility Captain James A. Lovell Federal Health Care Center remains on track for March 2024.

The VA says that restarting the rollout will require VA success metrics to improve at its live sites and for go-live at the Lovell facility be completed successfully.

In the committee hearing, Oracle EVP Mike Sicilia blamed previous VA problems on Cerner technical issues. He added that the VA’s lack of repeatable process has hampered the implementation as compared to the DoD, although he believes the VA is on track.

In a related item, Rep. Greg Murphy, MD (R-NC) said in a House Veterans’ Affairs Committee hearing that it is “inexcusable” to be rebuilding the VA’s Oracle Cerner system five years into the project, adding, “There are other systems out there that are much better.” Murphy is a practicing urologic and renal transplant surgeon at ECU Health (formerly Vidant Health), which uses Epic.


Reader Comments

From HisTalk2Fan: “Re: Larry Ellison’s comments about the Cerner Millennium rewrite made in the earnings call this week. What is your thought?” My reaction to the call in general:

  • Blaming the former Cerner’s revenue recognition practices for Oracle’s quarterly financial disappointment seems to throwing the acquired company under the bus, which Oracle has also done in attributing the VA’s implementation problems to Oracle-discovered Cerner technology deficiencies.
  • The oft-repeated goal to “drive Cerner profitability to Oracle standards” sounds good to stock analysts, but perhaps less so to customers or prospects who aren’t looking forward to higher bills or reduced service due to cost-cutting layoffs.
  • Oracle talks about rewriting Millennium using code generators, but has said nothing about product roadmaps or the layoff-caused lack of clinical resources that would be needed to design, test, implement, and support a rewritten Cerner product. They have stopped talking about Millennium’s weak areas – like not offering a competitive RCM system — and instead talk only about moving the product to the cloud.
  • Oracle talked up the development of a hands-free voice interface and increased availability of AI/ML in the December 2021 acquisition announcement, where it also pledged that Oracle would “maintain and grow Cerner’s community presence” in Kansas City.
  • The company says it will announce two new contracts worth a combined $1 billion this quarter. My bet is that these are outside the US, where Oracle has said it will expand Cerner sales to create “a huge additional revenue growth engine.”
  • I know little about code generators, but the idea that old code or new specs can be fed into a tool that will effortlessly spit out perfect code has never worked. And while customers might (or might not) benefit from a move to Oracle’s cloud, technology changes alone don’t often excite the market. I doubt that the decision of UPMC and Intermountain to move to Epic was driven by Millennium’s infrastructure.
  • Oracle has failed to deliver (and now doesn’t mention) the promised rewrite of Millennium Pharmacy for the VA as the first step in Millennium’s transition, which it assured the Senate Committee on Veterans’ Affairs would be finished by April 2023.
  • My big-picture takeaway is that the Cerner acquisition was Larry Ellison’s pet project, but now the bean counters are charged with making the healthcare cash register ring, which has been tried by big companies many times with a success rate of 0.0. Meanwhile, Oracle Cerner headlines mostly involve flagship customer attrition and Mike Sicilia slathering corporate concealer to cover its VA black eye.

HIStalk Announcements and Requests

Listening: Living Colour, whose 40-year history I had missed until a social media mention sent me to Spotify to learn more. The New York City funk metal band has remarkably kept the same lineup since 1984 other than swapping bass players in 1992. They were boxed out of entire genres that should have made them famous due to ever-changing musical tastes, record label pigeonholing, and lack of support for most black artists, but they just keep doing what they do.


A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference

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  • Looks like about 300 attendees, with key themes of AI, member engagement, health equity, bringing digital solutions to the customer experience, and some discussion about analytics and interoperability.
  • It’s about as low-key as healthcare conferences get (HLTH will be a shock after this). Quality is good, speakers are specific with evidence and examples, and panelists who are pressed to predict the future seem to have anxiety that no one knows what the payer world will look like in a few years.
  • John Halamka says that Mayo is focused on low-risk use cases of generative AI, such as drafting appeals letters and replying to patient messages. They are thinking about use in prior authorization, but haven’t done anything. He says B2C AI tools are too risky because of hallucinations and the risk of giving patients incorrect information. He concludes that when working with AI startups, it is critical to separate fact from fiction.
  • A panel says that AI-powered ambient listening and documentation is a big opportunity, but adds that the onslaught of AI tools has been hard to triage.
  • California-based Manifest MedEx is using data on 36 million Californians – from EHRs, immunization registries, EMS EHRs, and claims – to promote health equity, although data normalization and consistency across data sources are challenges.
  • Oscar has a platform that creates patient interventions and messages based on knowledge about that person, such as recommending that a care manager arrange a specialist referral in response to a chatbot question, while Cambia has an initiative to lower the out-of-pocket medication cost of members. They say the message must be matched to the patient, such as tailoring to the local Spanish dialect used, and sent via the patient’s preferred communication method.
  • One presenter expressed concern about trends such as fewer providers accepting Medicaid, wondering if low-income patients will eventually be limited to virtual care only.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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


Acquisitions, Funding, Business, and Stock

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML.

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Digital therapeutics vendor Akili, which sells a videogame that is an FDA-approved treatment for ADHD, will lay off 40% of its headcount and abandon its business model that involves prescriptions and payers. The company will sell directly to consumers with no prescription required, saying that payers were standing in the way of patients receiving treatment. The company went public via SPAC merger in August 2022, with shares opening at $36 but falling to $4 within a week as another spectacular but highly profitable failure from SPAC king Chamath Palihapitiya. AKLI shares are now at 90 cents, valuing the former unicorn at $70 million. 

Politico reports that private equity acquisition of hospitals and nursing homes, financed with low-interest loans, are at risk for layoffs and bankruptcies as higher interest rates eat into their profits. Federal agencies such as CMS and the SEC are alarmed over the undisclosed debt and the involvement of PE firms like The Blackstone Group – which holds $1 trillion in assets and controls businesses that employ 12 million Americans – that walk away from acquired companies after milking quick profits and management fees.


Sales

  • CommonWell Health Alliance names Ellkay as its technical service provider, where it will provide the interoperability infrastructure to support current requirements and CommonWell’s goal of becoming a QHIN under TEFCA.
  • Central California Alliance for Health will implement ZeOmega’s care management solution.

People

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Rhapsody hires Sagnik Bhattacharya, MS (HealthEdge) as CEO.

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Thirty Madison names Gil Shklarski, PhD (Flatiron Health) as CTO.

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TeleTracking hires Nigel Ohrenstein, MA (Kaia Health) as president.

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Julia Bernstein, MBA (Thirty Madison) joins behavioral telehealth provider Brightside Health as COO.

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Bruce Gray, MBA (HIMSS) joins WPS Health Solutions as chief information and digital officer.


Announcements and Implementations

Blue Ridge Medical Center earns Rural Emergency Hospital designation with the assistance of Medhost and its REH package.

UT Health San Antonio and UTSA launch a five-year MD/Master of Science in Artificial Intelligence degree program.

Geisinger goes live on Exo Works, which integrates ultrasound documentation with its EHR and PACS.

The newly announced Apple Watch Series 9 adds the ability to use Siri to request on-device health and fitness information, such as data from connected monitors, and to log health data such as weight and meds.

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Aridhia Informatics and Replica Analytics will collaborate to offer an end-to-end research data-sharing platform for research hospitals, pharma, and global consortia.


Other

The government of China cracks down on doctors who accept illegal commissions from drug companies for selling their products to patients, supplementing their “very small” salaries with “red envelope” money that can make up a significant part of their income. A previous study also found that one-third of patients had bribed their own doctor to get better treatment.

The Philadelphia newspaper notes that Children’s Hospital of Philadelphia paid its CEO $7.7 million in 2021, exceeding the amount of charity care the hospital provided in the three previous years combined.


Sponsor Updates

  • EClinicalWorks publishes a new customer success story, “Unlock Healthcare Benefits with Healow.”
  • CereCore releases a new podcast, “Liverpool Women’s CIO on the EPR Implementation Journey.”
  • Arcadia announces that ACO using Arcadia Analytics outperformed the market in Medicare Shared Savings Program bonuses by nearly 20% on average in 2022.
  • Elsevier Health publishes its Clinician of the Future 2023 report, highlighting the new ways in which technology will provide relief for healthcare workers.
  • InterSystems will sponsor HackMIT September 16-17 at MIT in Cambridge, MA.

Blog Posts


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Currently there are "3 comments" on this Article:

  1. Your skepticism about code generators is well-founded, despite qualifying that you know little about them.

    CASE was a giant failure.
    InfoBlox failed (and a lot more that I cannot remember at the moment).
    5GL mostly failed, and 4GL turned out to be essential, but a niche solution.
    Object languages have their role, but again niche.
    Late binding systems have value, but downsides too.
    Dynamic typing is convenient but sometimes results in expected type conversions!

    I’m a programmer and I feel qualified to comment. There is such a thing as meat-and-potatoes requirements. CRUD wouldn’t be a thing if there were not.

    However in the end, software is more like writing a book, than simple correlations of inputs to outputs. Really successful software involves genuine creativity, insight, and understanding what the tech is good at.

    The worst thing about code generators though? The specifications are never complete and they are never accurate. Code generators require you to commit on the basis of incomplete specs and users who are unable to fully articulate what a satisfactory solution would be.

    • Not a programmer, but can extend this argument even farther.

      Code generators pointed at old code will reproduce old errors. Code is dynamic in that as it is used its purpose morphs over time, and code is rarely ‘cleaned’ of old usages. Decisions that were made early on may have been right at the time, but no longer correct behavior given a new set of needs. A little white box spelunking of legacy code will demonstrate significant changes over time and pathways that appear valid but have been turned off via other mechanisms.

      Pointing a code generator at this is a train wreck waiting to happen and will delay implementation even further — with an untestable solution being the result. Your only option at that point is to let the users test the solution — which is fine for something ubiquitous like a word processor (early Word anyone?) but is absolutely unacceptable for an EHR. On top of that, it is a rare thing indeed for a user to know what a defect sniff is, and to know how to pursue the sniff, or it is also rare for a user to be able to articulate a blatant bug in such a way that would make it easily remediable. This will throw the whole solution into chaos.

      Just thinking that this unproven technology will solve the problem demonstrates how little Oracle knows about medical software.

  2. Upvote for Living Colour. And I had lost track of them too, after their initial breakout success.

    “Cult of Personality” is a wonderful song. Hard driving yet lyrically interesting too. A read standout and it holds up 30 years later!







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