VA-Cerner numbers skyrocket

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

VA’s CERNER NUMBERS SKYROCKET: We’ve noticed this week that members of Congress are batting around a new estimate for the Cerner EHR implementation job. Whereas $10 billion was the number on the Hill until recently, House Veterans Affairs Chairman Phil Roe gave a $15 billion figure Monday, and Debbie Wasserman-Schultz threw out $16 billion during an appropriations hearing with VA Secretary David Shulkin on Thursday morning.

The explanation, according to material provided to congressional sources, is a breakdown for the 10-year modernization project consisting of $10 billion for the Cerner contract, $4.6 billion for infrastructure improvements and $1.2 billion for program management support (VA has already awarded $750 million to Booz Allen Hamilton in this category).

Of the $15.8 billion total, VA officials have told Congress they will seek $10 billion in new appropriations, and reprogram $5.8 billion over the 10 years.

At the hearing, Shulkin said he “deeply regrets” the distraction surrounding his status at VA, adding, “I believe we are getting back on track” with a focus on veterans affairs, rather than his.

As for the Cerner contract, Shulkin assured that Cerner will offer open APIs without intellectual property protections, and that the implementation will be “physician-led and -driven.” The contract will move forward after “a few more reviews … hopefully soon.”

“I’d expect the number to go up further during the program,” said former VA Chief Information Officer Roger Baker, who estimated $16 billion for the project several years ago. “The bigger issue remains whether either VA or DoD can actually be successful in the transition, and what the definition of ‘successful’ is. Massive federal IT programs are notorious for failure, and these are two of the biggest.”

MEDICARE, MEDICAID COMMISSIONS REPORT ON TELEHEALTH: On Thursday, MedPAC (the Congressionally-established commission on Medicare) and MACPAC (the same, but for Medicaid) put out hefty reports to the legislature on their respective programs, focusing in part on telehealth. Neither offer unadulterated enthusiasm about the technology, though MACPAC praises specific modalities (like teledentristy), while MedPAC states that “[r]esearch to date offers a mixed picture of the efficacy of the various types of telehealth services.”

MedPAC takes the position that Congress should expand reimbursement in limited fashion and allow providers to experiment with telehealth under alternative payment models. MACPAC notes simply that the federal barriers to telehealth reimbursement in Medicaid are low.

JARED KUSHNER AND SEEMA VERMA FORGE AHEAD ON HEALTH DATA: President Donald Trump’s senior advisor and the CMS administrator took to Recode Thursday to plug their new health data initiative, which they announced last week at HIMSS.

As eHealth’s Darius Tahir reported, the two have said they would crack down on information blocking, increase patient access to health records, and press for interoperability standards. Details on the wide-ranging and ambitious initiative, called “MyHealtheData,” are scarce, but that hasn’t stopped Verma and Kushner from promoting their plan.

“While tremendous progress has been made in ensuring health providers use Electronic Health Records (EHRs), patients too often are not able to access and share their records, and their doctor often lacks the complete picture of their health,” the two write in the Recode post.

“The days of finding creative ways to hold patients hostage to a particular health care system soon will be over. It will no longer be acceptable to limit access to patient records or prevent patients and their providers from seeing their complete health history.”

Recode invited Aneesh Chopra, former White House chief technology officer, to point out what’s missing. “Alas, there isn’t an ‘easy’ button to make it happen magically with policy statements,” he writes. He recommended focusing on cultural factors -- patients might not even know to ask for their medical records, for instance -- and encouraging industry to adopt health data standards.

eHealth Tweet of the day: Elisabeth Rosenthal @RosenthalHealth My optimism 4 future of healthcare: 1) patients are standing up for themselves 2) Employers are fighting back ie Amazon/Berkshire deal 3) Doctors are becoming aware of prices and standing up for their patients esp young docs & med students! This should be about hc not biz!

And one from our colleague Sarah Karlin-Smith: @SarahKarlin: This is one of those stories that has made that has made covering @SGottliebFDA‘s time at #FDA fascinating & different from following other Trump admin officials. While there are exceptions to this rule, he is doing a lot that is universally embraced by folks on all sides of political spectrum

@JasonMillman The Trump administration wants to make cigarettes less addictive. http://politi.co/2perHI0 via @politico @sarahkarlin

IT’S FRIDAY at Morning eHealth where your author is wondering what tangible ways you see major consumer tech companies like Apple changing the patient experience. Send anecdotes to [email protected] and share them socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

GOOGLE SAYS AI CAN DIAGNOSE RETINOPATHY: Google researchers have concluded that their disease detection software was improved after being trained on images of diabetic retinopathy, a condition causing damage to blood vessels in the eye, MobiHealthNews reports. According to the study published in the journal Ophthalmology, the algorithm’s success was roughly the same as that of retinal specialists.


IN LETTERS TO CONGRESS:

— CHIME calls for better PDMP sharing with CMS: The College of Healthcare Information Management Executives argued in a letter to the House Ways and Means committee that data sharing between state prescription drug monitoring programs and other groups must be improved.

The group urged Congress to remove barriers to the development of a patient identity matching system, without which, they wrote, data cannot be widely shared. They also said clinicians need better access to PDMP information that’s frequently not integrated into EHRs.

— Support for Jenkins-Matsui bill: The Behavioral Health Information Technology Coalition supports is urging support for H.R. 3331 (115)from Reps. Lynn Jenkins and Doris Matsui, that would authorize CMS’s Innovation Center to operate health IT demonstration programs for behavioral health providers. In a letter to the House Ways and Means Committee, the coalition urges lawmakers to include the bill in their opioid package.

“It is time to end the use of paper records and faxes in the delivery of mental healthcare and addiction treatment in America,” the group states. Certain aspects of e-prescription, for instance, only work if mental health and addiction treatment providers have EHRs that support that function, they write.

WHAT WE’RE CLICKING ON

—Cerner implementation frustrates a Connecticut hospital

—Citizen’s Deven McGraw talks health care privacy

—Police use iPad-based “telemedicine” to respond to calls involving the mentally ill

—White House declines to show support for Shulkin