More experts weigh in on Cerner deal

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

SIGNING THE DEAL WAS THE EASY PART, VOLUME 2: Now that VA has finalized its contract with Cerner for a massive EHR implementation, Morning eHealth’s Arthur Allen has been canvassing health IT experts about next steps (read the first installation here.) Here’s what they’re saying:

Stephan Fihn, former director of analytics and business intelligence, Veterans Health Administration: Involve local clinicians to optimize workflows and maximize their efficiency. Prepare for an implementation that will be difficult and fraught with challenges, expected and unexpected. After calculating the number of train staff needed, double it. VA has stored two decades of clinical data on 20 million veterans. High quality and safe care necessitates integration of historical data with current clinical information. This will be difficult because VA data are poorly standardized.

David Kibbe, CEO, DirectTrust: The VA should take advantage of Cerner’s significant capabilities for nationwide interoperability of health information exchange, so as to quickly advance electronic communications between VA facilities and providers in the private sector who share the treatment of veterans. For example, Cerner is one of the EHRs that has access to the DirectTrust Provider Directory, which contains the DirectTrust addresses of over 700,000 providers in over 50,000 health care organizations around the country. This can help the providers and staff in the VA facilities locate the DirectTrust addresses outside the VA, and to use Direct exchange to coordinate care by sharing important clinical and administrative data with providers in private sector hospitals, medical clinics, health departments and medical practices using other EHRs. The new secretary should monitor the cultural shift carefully. Many at the VA have spent significant portions of their careers working on and improving the VistA EHR that is now being replaced. This has got to be gut wrenching for some of the VA’s employees.

Christoph Lehmann, Vanderbilt professor, president of the International Medical Informatics Association: It’s the implementation, stupid! When Cerner implemented an EHR in 2005 in a children’s hospital, anunexpected rise in mortality was observed. We have learned since then that to guarantee the safety of our patients, these type of large scale implementations must balance standardization of content like orders or medication, to improve quality of care and local customization, with “break-the-glass” functionality to reflect local workflows and areas of expertise and excellence.

Andrew Wiesenthal, managing director, Deloitte; led Kaiser Permanente HealthConnect implementation: This is the cascade of work that the VHA has to do if they are going to succeed (and these recommendations are independent of vendor choice): Develop a clear vision for the future state of the VHA. What kind of health care ought they be delivering in, say, 2030? Where will it be delivered? Who will deliver it? How will veterans ideally interact with the system? Once they have a clear vision for their future state, they then need to engage their entire staff in what is really a massive change management project, not a technical project. They are replacing a reasonably popular, proprietary system, created and evolved by their own staff. How do they turn that staff into the owners of a change to a new system that they have had no role in developing? Once they have staff engagement, then the intense focus must be on workflow configuration and content design, with a clear eye toward the vision.

Nancy Anthracite, director, WorldVistA: You must keep all of the data in VistA, and not just the corporate data warehouse data. It is very valuable for care and research. You must prove you can exchange data with the DOD better than the VA already does. Take your time. Implement Cerner slowly and carefully. If you deploy Cerner rapidly you will end up with the same problems as the DoD. Keep VistA working so you have a fall-back option when costs spiral out of control, which they likely will as you try to replace all of the EHR and non-EHR functionality that VistA provides.

Stan Huff, chief medical informatics officer at Intermountain Healthcare: To create the kind of system that is required the VA needs to help Cerner make good on its intentions to become a standards based platform rather than a provider of an all-inclusive set of proprietary solutions. The ability to purchase 3rd party applications is essential to success, along with interoperability with private hospitals where veterans will increasingly get their care. Adherence to standardized HL7 FHIR APIs is the key technical strategy. Focusing too much on getting the current Cerner system installed quickly everywhere, rather than focusing on providing a quality solution for clinicians and patients, will doom the project to failure. Focusing on realizing clinical value from the system is much more important than meeting an arbitrary timeline.

eHealth Tweet of the day: Brian Eastwood @Brian_Eastwood Came across this headline for a research report: “Innovations will Boost Patient Engagement Solutions Market Growth in the Foreseeable Future.” My brain just asploded.

It’s TUESDAY at Morning eHealth where your author has recently eaten a horrifying amount of khachapuri. What other European snack foods should she sample that induce less guilt? Send ideas and news tips to [email protected], or Tweet them to @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

POLITICO and the South China Morning Post are partnering to expand coverage of U.S.-China relations. Read our note from POLITICO Editor-in-Chief John Harris and Editor Carrie Budoff Brown to learn more.

SUPREME COURT BACKS EPIC IN ARBITRATION CASE: A narrowly divided Supreme Court published a decision Monday reaffirming that employers can require workers to waive rights to participate in class action lawsuits. EHR vendor Epic was one of three cases addressed in the decision.

“It is important that employers protect an employee’s right to file complaints, while also providing for a fair forum in which those grievances are addressed,” Epic Founder and CEO Judy Faulkner said in a statement. “When it comes to grievances regarding wages and hours, we believe individual arbitration agreements strike that reasonable balance and are pleased with the court’s decision in support of this.”

Justice Neil Gorsuch wrote the 5-4 opinion, concluding that mandatory arbitration clauses are acceptable elements of employment contracts. Epic was only directly mentioned in Justice Ruth Bader Ginsburg’s dissenting opinion, which noted that Epic’s email of an agreement requiring wage and hours claims to be resolved via individual arbitration, Morning eHealth’s Darius Tahir reports. As workers could not forego signing and keep their jobs, Ginsburg termed the decisions faced by Epic’s employees a “Hobson’s choice.”

RESEARCHERS QUESTION PDMPs’ EFFECT ON DRUG OVERDOSES: Just a small percentage of academic publications link prescription drug monitoring programs to opioid overdoses, a group of researchers has concluded. In an analysis of about 2,600 publications, only 10 made that connection, and those studies found limited evidence of a reduction in fatal overdoses, according to UF College of Medicine’s Chris Delcher. Their review, appearing in the Annals of Internal Medicine, also highlights three studies that associate PDMPs with an increase in fatal heroin overdoses. “When you crack down on prescription opioids, it means that people sometimes turn to other sources,” Delcher said in a news release.

REPORT: INSURERS MUST GET DIGITAL TO REACH BOOMERS: An Accenture reportargues that health plans should update their strategies for marketing to baby boomers, especially as more than half of them say they’ll go online to shop for Medicare.

Scott Brown, Accenture’s managing director of payer consulting, tells Morning eHealth that to remain competitive, health plans should be thinking “beyond the traditional approaches of just mail” — branching into email and text communication, for instance — and reaching out to potential patients before they turn 65. Health plans could also up their competitiveness by investing in technology that could auto-suggest specific plans for specific patients, Brown said.

IORA HEALTH RAISES $100M IN SERIES E FUNDING: Iora Health, a primary care provider focusing on Medicare patients just raised $100 million from investors including GE Ventures, Khosla Ventures, Polaris Partners and Humana, according to a news release.

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