DoD Cerner install: Broke so far

With help from Arthur Allen (@arthurallen202) and Mohana Ravindranath (@ravindranize)

DoD CERNER INSTALL IS BROKE SO FAR: The Department of Defense’s Cerner installation is broken badly so far, our colleague Arthur Allen reports. Physicians at the four northwestern military sites at which the Cerner EHR is being installed are complaining of kludgy systems and long log in times. And while it’s difficult to precisely attribute any one adverse event to a specific software problem, Patient Safety Reports — which are required whenever a life- or limb-threatening medical error is discovered — were “being filed almost every day” in the first few months, said one physician at Bremerton.

“The bottom line is ... the Cerner user build is immature and needs to be brought up to a functional level,” another doctor said. “There were some expectations at higher levels that this ... was an out-of-the-box solution that would work perfectly, but it didn’t.”

Cerner and Leidos say the problems are temporary speedbumps; meanwhile, Jared Kushner was selling the program in sparkling terms a couple days back at HIMSS. Pros can get the rest here.

STRUGGLES AT VA CONTINUE: Meanwhile, the other part of the Cerner installation train — the Department of Veterans Affairs — is mucking around in the slop. Wednesday, another report from the department’s Office of the Inspector General faulted the agency — this time for “critical deficiencies” in the Washington, D.C., VA Medical Center.

While the most worrying allegations didn’t concern IT matters — the report said that some ostensibly clean areas were not — the center was sloppy in handling private health care information. It said 1,307 boxes were left unsecured and improperly stored, leading OIG to take possession of the records; 1,058 of those boxes housed private health information, including “individual patient pulmonary function studies, veterans’ identification cards, patient health records and films, as well as personnel and other administrative documents.”

Meanwhile, whispers that VA Secretary David Shulkin is not long for the job continue to brew; a Daily Beast report argues that his days are numbered, in an unspecified way.

All these struggles — ranging from real-life failings to more evanescent chatter — are swirling while the agency tries to complete its $10 billion acquisition of a Cerner EHR. At a Wednesday House Veterans Affairs’ Oversight and Investigations Subcommittee hearing, the timeline on that got no clearer.

Rep. Ann McLane Kuster, the subcommittee’s ranking member of the subcommittee, said she believed Shulkin would sign the Cerner contract by the end of the month. But Fred Mingo, director of program control at the VA’s Electronic Health Record Modernization Program, said he was “as anxious as anyone in this room to hear an award date,” while demurring on when Shulkin would put pen to paper. Mingo also wasn’t able to explain why the contract had yet to be signed, saying there were two issues — before catching himself and saying he’d submit the answer later, for the record.

Shulkin himself enjoyed the support of one of the witnesses from veterans’ organizations. The American Legion’s Louis Celli Jr. declared that the “Secretary [is] under fire by ideologues” at a time when he needed the support to begin the mammoth task of converting the VA to a new electronic health record.

The hearing had an official subject: consideration of a few reform bills. Two of them directly concern health IT matters: the first ( H.R. 3497 (115)), sponsored by Rep. Cathy McMorris Rodgers, would support a pilot project to give veterans a gadget that would store – and allow them access to — their medical records. That bill was opposed by the VA, and split the witnesses from the veterans organizations present.

The second bill, the Veterans EHR Modernization Oversight Act of 2017 ( H.R. 4245 (115)), requires the VA to submit documents and update Congress about the progress of its EHR project.

eHealth tweet of the day: Genevieve Morris @HITpolicywonk 19,123 steps yesterday at #himss18 pretty sure that’s a personal record, and one I hope never to accomplish again.

THURSDAY: Your correspondent is heading to Morocco within a month. Any recommendations? Make them to [email protected]. Don’t share them socially at @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth because we wouldn’t want these tourists to overrun the place.


CONFERENCE NOTES: This week has been jammed with conferences. Some select tidbits:

— HIMSS: The desert conference has been popping. Our colleague Mohana Ravindranath reports that ONC is planning to shutter its Office of Consumer eHealth as a consequence of the Trump administration’s proposed budget cuts.

Asked how ONC would continue patient engagement work, agency director Donald Rucker said reaching patients is a “complex business activity,” while his team is a “software-focused operation.” ONC can try to encourage companies to reach out to patients using software tools ONC has promoted, he said.

“Do you really think ONC is better at convincing patients to access their data, or Apple, or Google, or any new startup that’s going to come?” he asked. “I think the answer to that is pretty clear.”

Speaking of Apple and patient engagement … UnitedHealthcare Motion — an employee wellness program that lets you earn money for meeting fitness goals — is available on the Apple Watch, the company announced at HIMSS Wednesday. UnitedHealthcare already partners with other wearable companies including Fitbit; vice president of emerging products Paul Sterling tells Morning eHealth that it will be evaluating the impact of the device on employee participation in wellness programs, but that the company’s primary goal in this partnership is to offer them a choice of which device to use.

— AHIP: Back in the swamp, America’s Health Insurance Plans held day one of its annual policy conference. Your correspondent attended two of the sessions, on opioids.

The first, a speech from deputy attorney general Rod Rosenstein, who discussed the administration’s enforcement efforts involving illegal drugs and inappropriate painkiller prescribing. Rosenstein indicated that health care data helped the Justice Department develop leads. Data, he said, is “not evidence necessarily of wrongdoing,” but allows the department to “focus on the outliers, who are far beyond their peers.”

Rosenstein was followed by a panel of various eminences discussing the crisis. The AMA’s Patrice Harris had an interesting statistic on prescription drug monitoring programs: usage of these databases has been increasing, according to a survey the association conducted, regardless of whether a state mandates checking it or not. (The AMA generally opposes such requirements.)

In 2014, she said, prescribers queried state databases 60 million times. In 2016, that number increased to 140 million.

OTHER LEGISLATIVE NOTES: Congress remains busy. Let’s keep you up to date:

— Spending deals: There are a host of policy fights gathering for the annual health spending bill. Conservatives are trying to advance policy priorities like defunding Planned Parenthood and one federal family planning program, and both sides are arguing about how much funding to direct to the opioid crisis. Efforts to stabilize the Obamacare markets aren’t looking much more successful, our Budget and Health Care colleagues say.

— Budget committee wants long-term savings work from CBO: During a Budget Committee hearing Wednesday, members from both parties urged the Congressional Budget Office to consider savings beyond the traditional 10-year window, our Budget colleague Jennifer Scholtes writes.

“This is something that we absolutely have to deal with if we’re going to do any kind of long-term thinking in this body,” said the committee’s ranking member, Rep. John Yarmuth, during the hearing. “We have to in some way figure out how to anticipate long-term implications — budgetary and otherwise.”

That’d be music to telemedicine and other tech advocates’ ears: they’ve long felt their gizmos and gadgets would prove their worth over the long term, or in other ways that CBO doesn’t presently capture.

— Telehealth advocacy during farm bill hearing: Anne Hazlett, the Department of Agriculture’s assistant to the secretary for rural development, suggested Wednesday that lawmakers could use the forthcoming farm bill to address the opioid crisis. That would include telemedicine grants, our Health Care colleague Brianna Ehley writes. The agency has been disbursing telemedicine-related grants over the previous year.

WHAT WE’RE CLICKING ON:

— The New Yorker’s Daily Shouts section asks: what is your online therapist doing?

— Former FDA commissioner Robert Califf discusses customized sharing of health care data in context of Alphabet’s Project Baseline project.

— Amazon is offering Medicaid recipients discounted membership in Prime.