How’s the Defense EHR implementation working out?

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

COST OF PENTAGON’S EHR IMPLEMENTATION RISES MORE THAN $1 BILLION: Taxpayers will have to shell out $1.1 billion more than expected for the MHS Genesis EHR project, our colleague Arthur Allen reports. The increase is attributable to the addition of the VA and Coast Guard to the platform, officials said in a media briefing today.

The military has posted an amendment to the $4.3 billion Cerner contract to give MHS Genesis the same software baseline the VA negotiated with Cerner in the deal it signed in May. You can find the in-depth details here.

The department is poised to roll out the software to a new set of bases, primarily in California, officials said.

— Reviewing previous implementations: Meanwhile officials provided an update regarding the already-established implementations. Some horror stories — which we reported on in March — have trickled out, with descriptions of faulty software, lengthy log-ins, and the full smorgasbord of “things that can go wrong when installing an EHR.”

Cummings and Vice Adm. Raquel Bono, the Defense Health Agency chief, said they had created a health informatics office to provide on-the-ground help with problems in the four initial MHS Genesis sites.

So things have gotten better, officials said. Log-in times are down to 40 seconds – an exponential decline from the 20 minutes it sometimes took in the fall. Help desk ticket count is down to under 1,200, from a peak of 14,000.

An internal investigative team completed several weeks of testing at Madigan Army Medical Center — the biggest of the four initial MHS Genesis sites — on July 13. An earlier report, you’ll recall, described MHS Genesis at the three smaller bases as “neither operationally effective nor operationally suitable.”

When POLITICO asked what a similar report on Madigan would mean, officials suggested that such dire assessments were a thing of the past, but feedback was always welcome. “Testing is an integrative part of our acquisition strategy,” said Cummings. “We test and enhance and test and enhance.”

Bono and Stacy Cummings, the project leader, took questions during a presentation at a military health IT conference in Orlando earlier in the day. One person asked, “How are we supposed to move forward on a commercial product that doesn’t do what we need?” Bono responded, “One of our biggest challenges is change management. This is a great time to reflect on what we do and to think, Is this the best way to do things?”

21st CENTURY CURES HEARING ON TAP: This morning, the House Energy and Commerce Health Subcommittee is hosting top officials from the National Institutes of Health and FDA to talk about the implementation of 21st Century Cures.

The hearing is likely to have a heavy digital component. In his witness statement, NIH Director Francis Collins gives shout-outs to the organization’s encouragement of data sharing and the All of Us genomic study. He’s got a new milestone to announce: 85,369 individuals have signed up for the study as of July 16. At least 70 percent of those sign-ups are from historically underrepresented groups, he adds.

The other agency present, FDA, will be represented by Administrator Scott Gottlieb. He’ll be speaking about digital matters with great enthusiasm, as is his wont. He gives shout-outs to electronic health records’ and high-quality registries’ role in providing real-life evidence to help approve new therapies, and track how well they do once they hit the market. He also touts his agency’s digital health plans, including the agency’s pre-certification pilot program. The full statement is here.

— Also in Congress: The Senate is considering a big bundled appropriations bill, combining Defense and Labor-Education-HHS bills, as a way to avert a government shutdown before the Oct. 1 deadline, our colleague Sarah Ferris reports. The stratagem is rare: observers couldn’t remember Congress trying this maneuver before.

eHealth tweet of the day: Jay Parkinson MD, MPH @jayparkinson “A tech solution to a political problem will fail 99.9% of the time. And once we fix the ‘do more get paid more’ hospital-centric business model and the tech will easily follow. The issue is who’s the ‘we’ who fixes it? I wouldn’t place my bets on an ad, hardware, or retail co.”

WEDNESDAY: This past weekend, your correspondent tried and failed to complete a quest. Like all of history’s great quagmires, it started with a seemingly simple task for a good cause: find and purchase poppy seeds for muffin-baking. Several supermarkets later, no poppy seeds. While the seedless muffins turned out delicious, the mystery is haunting: where are the seeds? Is this some sort of drug-testing worry? Answer the questions by email at [email protected]. Discuss socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

NEW TELEHEALTH BILL COMING TO THE HOUSE TODAY: A new bipartisan bill aims to reduce hospitalizations for the elderly by increasing access to telehealth and first responders, our colleague Mohana Ravindranath scoops.

The “Reducing Unnecessary Senior Hospitalizations Act of 2018,” or the RUSH Act, would let group practices provide those telehealth and first responder services to Medicare beneficiaries at skilled nursing facilities, according to a discussion draft.
Reps. Adrian Smith, Diane Black, Joe Crowley, Morgan Griffith and Ben Ray Luján plan to introduce the bill today, multiple spokespeople confirmed.

The initiative has garnered support from lobbying group Health IT Now. Executive Director Joel White says telehealth could be the solution to the “‘better safe than sorry’ practice of sending patients to the hospital.” The group anticipates “an aggressive advocacy campaign to secure its passage before year’s end,” he said.

FCC TELEHEALTH PILOT COULD SUPPORT BROADBAND DEPLOYMENT: Nascent plans for a $100 million telehealth pilot may focus on funding broadband providers, commissioner Brendan Carr said at an ACT | App Association event in Washington Tuesday.

Carr announced the concept, which intends to support remote monitoring programs for low-income Americans, along with Sen. Roger Wicker earlier this month. If plans for the program are formalized, some of that money could go straight to health care providers testing out telemedicine — but funding the broadband connections themselves involve less legal red tape, he explained.

Even once broadband is widely available in rural areas, limited reimbursement for telemedicine services will likely remain a challenge, he said. Part of Carr’s goal is to provide groups such as CMS with data showing that telemedicine is cost effective. “A lot of the data isn’t there,” he said.

FORMER CERNER EXEC TO TAKE OVER AT DIRECTTRUST: Scott Stuewe, who will take over as the president and CEO of DirectTrust in September, tells Morning eHealth the group will likely focus more on ensuring consumer health products are secured.

DirectTrust’s messaging protocol, which lets providers exchange health data, is just one part of an “overall landscape” of information transfer, he says; the organization’s niche is focused on identity proofing and accreditation, he said.

Going forward, Stuewe expects the group to have more conversations with consumer tech companies such as Apple — which now lets some users download their EHRs straight to their phones — about security standards.

Currently DataFile Technologies’ director of strategy and interoperability, and formerly Cerner’s director of national interoperability strategy, Stuewe succeeds David Kibbe, who stepped down earlier this year after leading the group since 2012. Pros can get the rest of Mohana Ravindranath’s story here.

CMS HAPPENINGS: A quick update on CMS’s agenda:

— New personnel: The agency is getting some high-profile new recruits. New officials include Paul Mango, a former Pennsylvania Republican gubernatorial candidate and McKinsey consultant, who will serve as chief of staff for the agency; and Chris Traylor, formerly a Texas state health official, will serve as the agency’s deputy administrator for strategic initiatives.

“We’ve set the policy agenda,” CMS administrator Seema Verma told POLITICO. “And Paul is responsible for executing on the agenda and the policy initiatives.”

Mango is an outspoken figure, reiterating anti-Obamacare stance from his campaign in a Monday interview. He also called himself a “true social conservative” during the campaign.
The personnel moves also touched a current official. Brady Brookes, the deputy chief of staff, earned a promotion, adding the deputy administrator title to the CV. Pros can get more details about the personnel announcements from our colleague Adam Cancryn’s story here.

— Speaking: Verma will be keynoting the first day of ONC’s interoperability conference, the office announced today. The conference is Aug. 6-8 in D.C.

NIH updates: The institutes made a couple noteworthy digital moves Tuesday:

— New awards: Five new research awards announced today focus on such areas as palliative care during ER visits for older adults with serious life-limiting conditions and testing how health IT can help emergency physicians start patients with opioid use disorder on the overdose reversal drug buprenorphine. Funding totals $4.15 million for one-year planning, with an estimated $30.1 million expected for four subsequent years.

— Google Cloud collaboration: The agency also announced a collaboration with Google Cloud Tuesday. The effort will unite biomedical researchers with access to advanced computational technologies — specifically, Google Cloud storage and tools. The institutes’ in-house researchers, and its 2,500 grantees, are the lucky beneficiaries.

WHAT WE’RE CLICKING ON:

—Trump appointee at VA spread conspiracy theories and anti-Muslim social media posts, CNN reports.

—How can real-world data inform researchers? An Annals of Internal Medicine opinion piece describes.

—Can Google Nest help with senior living? CNBC reports they’re exploring the question.