Experts chime in on VA’s next steps for Cerner deal

SIGNING THE DEAL WAS THE EASY PART: Now comes the VA’s difficult implementation of the Cerner system, which is expected to take 10 years. The deal says Cerner will get no more than $10 billion for its trouble, but many experts expect at least another $5 billion to be spent on all the change management that will go into the deal.

We decided to ask some experts for their advice on how the VA should proceed to make this enterprise successful. Here are some of their responses (more in Tuesday morning’s edition!):

David Shulkin, former VA secretary: Get VA clinical leadership buy-in. Form a veteran advisory committee (with veterans of all generations) to give input to implementation. Set transparent metrics and measurable outcomes.

Scott Blackburn, former VA chief information officer: Get the right executive leadership in place and make those people truly accountable. Who on the secretary’s team will be going to bed every night truly accountable for making John Windom and the EHR modernization team successful and will be every night for at least the next 2.5 years? Right now, there is an Acting Undersecretary of Health, an Acting Principal Deputy Under Secretary of Health, and an Acting CIO — all of whom, even if permanent, have a lot else on their respective plates. There needs to be an executive for whom this is the #1 priority, who is willing to roll up his or her sleeves, understand the issues, be empowered to make executive decisions, remove roadblocks and make sure VA isn’t repeating mistakes that have been made already by DoD and so many other private health care systems.

2) Make sure EHR Modernization is led by clinicians and the Veterans Health Administration (VHA), rather than the Office of Information and Technology. EHR modernization is a business transformation enabled by technology, not an IT project with clinical support. VHA has to have the right clinical leadership dedicated to making this successful at the pilot site(s). It must pull its “A” players out of their jobs and dedicate them to this. It will be much better to over invest in resources rather than under invest.

3) Focusing on winning the hearts and minds of those at the initial pilot sites. As [former VA CIO] Roger Baker has pointed out, VA is going to face a tough challenge in that VA clinicians like VistA and feel VistA is “theirs.” VistA has a rich history of entrepreneurism and innovation within VA (e.g., the “hardhats”); and many VA clinicians take a lot of pride in that. For this to be successful, VA clinicians are going to have to feel that same sense of ownership. If VistA was the first EHR revolution in VA, we are going to need a band of “hardhats 2.0” to make this the second EHR revolution in VA. Honor the history; and use that history as a strength to make this next chapter successful. Stay laser-focused initially on 1-3 pilot sites to make sure those are successful before scaling. Go slow to go fast. Make sure VA is getting ahead of infrastructure upgrades at the pilot sites. This needs to start right now. This was one of the lessons learned from DoD.

4) Communicate, communicate, communicate. This historically has not been a strength of VA. Everyone is going to want to know what is going on – the good, the bad, and what is being done to address the bad. Constant communication and coordination with DoD.

Peter Levin, CEO, Amida Technology Solutions, former VA chief technology officer: We’ll lose years of time and billions of dollars - never mind put patients at risk - if we don’t have measurable, auditable, reliable, and secure clinical data exchange. If you get the data exchange right, nothing else matters (because the clinical components can be aligned and fixed later). If you don’t get the data exchange right nothing else matters (because you will never be able to fix or align the clinical components later).

Roger Baker, consultant, former VA CIO: 1) Focus on the doctors. Make sure they view the new system as a win. What’s in it for them? 2) Say no. No slips, no new requirements, no excuses. Be willing to stop the program or replace any part of it that isn’t meeting scheduled deliveries. Be ruthless. 3) Stick to the commercial product. It works. Make sure any deviations are based on better quality of care. 4) Empower your people. Let them make decisions and mistakes. 5) Hold people and companies accountable. There is no excuse that justifies impacting veteran care. None.

John Halamka, CIO, Beth Israel Deaconess Medical Center: Implementing an EHR is more about psychology than technology. It’s all change management.

… to be continued.

Tweet of the Day: SF-VETERAN @FiolYadyra VETS, NOW WONDERING IF WE’RE GONNA BE SAVED OR BLINDSIDED ONCE AGAIN. @Cerner #vawaitimes #noaccountability #cutnpasteexamnotes #papertrailappointment #pharmwaitimes #cluelessdocs #proceduregonewrong #deadlysurgicalmistakes #malpractice-rinse-repeat

Welcome to Monday Morning eHealth where we’ve been so caught up in the Cerner-VA drama that we’re feeling both relief and journalistic phantom limb syndrome. Send tips on the next big story (not that we’re abandoning this one) to [email protected]; send news tips also to @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.


IN THE JOURNALS: Health informatics interventions pose a particular risk of disproportionately benefiting better-off people and increasing inequality, Tiffany Weinot of the University of Michigan and co-authors write in the newJournal of the American Medical Informatics Association. In another article in the journal, scholars from Lehigh University and the Lehigh Valley Health Network write that ambulatory physicians in a health system — with the exception of OB/GYNs — were generally less satisfied with EHRs than other staff, and patient satisfaction dropped after initial EHR installation

…. In the Journal of Ambulatory Care Management, meanwhile, authors describe a successful PCPI-American Medical Association pilot aimed at closing referral loops.

… The American Journal of Public Health publishes former ONC chief Karen DeSalvo and Columbia’s Clara Wang, who argue that “geographically granular and timely intelligence is an essential infrastructure” for public health.

WHAT WE’RE CLICKING

—Fayetteville Observer: Wilkie has to step down before he can lead the VA

—Insider Sources: Point and Counterpoint arguments for and against the privatization of VA medical services

—Boston Globe: Ajit Pai and Newton Minow write that the digital divide is slowing telemedicine

—Washington Post: Virtual therapists help people with eating disorders in grocery stores

—Histalk: Cerner executive blames Epic and “fake news” for unpleasant coverage of DoD implementation in Pacific Northwest