Cerner slogging through VA delay

With help from Arthur Allen (@arthurallen202), Paul Demko (@pauldemko) and Mohana Ravindranath (@ravindranize)

CERNER SLOGGING: The first quarter of 2018 was not a kind one for Cerner. The company’s net earnings declined by $13 million so far this year when compared to a similar period in 2017, the firm announced Wednesday. The reasons are not exactly mysterious: Cerner’s president, Zane Burke, acknowledged during the earnings call that the delay in the VA contract contributed to the decline. What’s more, the company doesn’t expect the deal to get signed until the latter half of the year.

Cerner has become snarled by politics. As our colleague Arthur Allen reported Sunday, a West Palm Beach doctor using an outdated version of Cerner’s software has gotten a bee up his bonnet – or perhaps a wasp down his white coat – about the software system. Because he’s part of the Mar-a-Lago social crowd, he’s gotten the ear of Marvel executive Ike Perlmutter, who has in turn pulled political strings with his friends in the Trump administration. That’s delayed the contract.

The delay in the deal has now riled up Congressional Democrats. On Wednesday, leading Democrats on the House Veterans Affairs Committee sent a letter based on POLITICO’s reporting to acting VA secretary Robert Wilkie and the department’s inspector general asking them to explain the reasons for the delays. The letter does not state a deadline for their request.

— Meanwhile...: Former Rep. Jeff Miller is one of the leaders in the clubhouse for the Veterans Affairs secretary nomination, the Washington Post reported, citing a Wednesday meeting between the former congressman and the White House’s vetting office. It’s by no means a certainty, but something to keep an eye on.

As a congressman, Miller was a proponent of expanding private sector options for veterans. While we haven’t been able to find Miller taking a firm position on the VistA switchover, he was highly critical of the Obama-era VA’s IT record in this FCW article.

— Video killed the prose star: Arthur also appeared on MSNBC early Wednesday to discuss his VA reporting. If you can’t bear to digest information in prose format, and prefer video, we understand — watch here. (Still, read the rest of Morning eHealth anyway, or at least convincingly pretend you have.)

ACOs COMING: Ready or not, it looks like a new Accountable Care Organization rule will be coming, as OIRA flagged receipt of a new regulation to review. As ever, we assume the regulatory experts there will be thorough and unpredictable, so we can’t quite predict when HHS will publish a rule updating ACO parameters.

Farzad Mostashari, who as CEO of startup Aledade has a vested interest in the performance of ACOs, offered his thoughts via a characteristically detailed tweetstorm. Mostashari appears concerned with how and whether CMS forces participants to take downside risk into account: “Based on what @SecAzar @SeemaCMS said I strongly suspect that they will propose a shortening of the period of 1-sided risk to reduce what they see as freeloading/ACO squatting

But runs risk of driving out a lot of good ACOs too

In last cohort, only 8/65 graduated to downside”

— Survey says: How important is the downside risk provision? Well, roughly seven in 10 of the original participants in CMS’ Medicare Shared Savings Program plan to drop out if they are forced to take on financial risk in order to continue, according to a survey by the National Association of ACOs. By contrast, three-quarters said they would stick with the program if they can remain in contracts that don’t expose them to potential funding decreases. The survey included 35 ACOs that joined the program in 2012 or 2013.

eHealth tweets of the day: [New CMMI head] AdamCMMi @AdamCMMi “Just three weeks in—already inspired by the CMMI team and our dedication to improving US health care. Go @CMSinnovates !”

[Old CMMI head] Patrick Conway @PatrickConwayMD @AdamCMMi following. Adam will do terrific as CMMI director! And he has an amazing team at CMMI and across CMS! CMMI is major force for transformation of US health system. He has to last 5 years to surpass my CMMI record or 7 at CMS. 😊

THURSDAY: If you’re reading this, your correspondent managed to beat a very, very localized power outage on his block. Suggest ways to improve Pepco’s effectiveness at [email protected]. Discuss the pains of a lack of electricity at @arthurallen202, @dariustahir,@ravindranize, @POLITICOPro, @Morning_eHealth.
Watch Live this morning as we discuss the state of the pharmaceutical supply chain and what can be done to be better control costs. Watch Deconstructing the Prescription Drug Supply Chain here.

USDS UPDATE: The US Digital Service — the tech troubleshooters recruited in the wake of the HealthCare.gov debacle — is looking for a new challenge at CMS, our colleague Mohana Ravindranath notes. The team just wrapped up work related to the Quality Payment Program, in which they focused on making data-reporting easier.

While some USDS squads are collaborating with the White House’s Office of American Innovation and CMS on the MyHealthEData initiative, they’re looking to find other tasks to occupy them.

SAMHSA, ONC RELEASE PART 2 GUIDES: The two branches of HHS released some new material guiding providers and others through 42 CFR Part 2 considerations. The first helps readers decide whether part 2, which protects behavioral health data, applies to them; the second, about how to exchange part 2 data.

JOURNAL REVIEW: An interesting harvest of journal articles to peek at today:

— Increasing EHR adoption in psychiatric care: A trio of Harvard-affiliated authors want to boost lagging EHR adoption in EHR care, and consider ways to do that in the latest issue of the New England Journal of Medicine.

“New models of health care coordination and integration are hampered because they demand the exchange of electronic health information between psychiatric and medical providers,” they write, and those models are hamstrung if psychiatric providers don’t have digital records. Yet the authors think three forces are hampering psychiatric providers: inadequate financial incentives; complex regulations; and unaccommodating EHR design.

“[F]ew EHR tools have been developed to support [psychiatric providers], and the ones that do exist are unworkable,” they write, noting that software designed for other specialties doesn’t take psychiatric billing or workflows into account.

Among other policy moves, they suggest that ONC require better patient-data-sharing tools as a part of EHR certification criteria.

— Algorithms: Algorithms developed by neural networks can detect retinopathy of prematurity better than many experts, a new article in JAMA Ophthalmology concludes. The network was trained and tested on a series of 6,000 retinal images, and then compared to diagnoses made by eight experts. The network outperformed six of them, leading the authors from Massachusetts General Hospital to declare at least early success. The authors mention testing with images taken by other types of cameras, among other unknowns, in future work.

— Health Affairs: Two notes from Health Affairs. First, one blog post considers the lessons for value-for-pay from hospice programs; second, the journal is considering submissions on aging and health.

ALL OF US LAUNCHES: NIH’s All of Us cohort continues to roll out, as the agency updated the online version of its protocol for the giant precision medicine study here.

MARK YOUR CALENDARS: The Departments of Defense and Veterans Affairs are holding an interoperability event May 17 from 8 a.m. to 2 p.m. You can RSVP here.

WHAT WE’RE CLICKING ON:

American Academy of Family Physicians blog post concludes the EHR market needs a vast competitive overhaul.
Hype and reality on cancer sequencing from Science Translational Medicine’s In the Pipeline blog.

NHS launches an inquiry on why a computer algorithm failed, leading to hundreds of thousands of women in the U.K. not getting a breast cancer screening invitation.

Why genetic studies are working so well in Finland.

Beth Israel Deaconess is launching a tech innovation center.