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VA Hospital Waitlist Story – Let’s Discuss

Posted on June 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw this above link on Twitter, and I was reminded of the VA Hospital Waitlist story. I’ll admit that I haven’t dug into the story deeply myself. I mostly understand that numbers were fudged because they bypassed the official waitlist system with one of their own. The article above points to this being a possibly much larger problem.

I’d like to turn this over to readers and hear your thoughts about what’s being reported, but more importantly, what can we learn from this story?

I look forward to reading your thoughts and discussing this story in the comments.

$11 Billion DoD EHR Contract

Posted on May 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more to it than EHR, but that will be the core of the contract and the big name EHR vendors will all be involved.

Here’s a section of the article which gives you an idea of the size of the contract:

The DHMSM contract’s estimated lifecycle value is approximately $11 billion and would include initial operating capabilities by 2017 and full functionality by 2023, according to Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, who testified in February before the House Appropriations Committee’s defense panel.

Even in Washington, $11 billion is a lot of money, and it would surely rank among the largest IT-related contracts in government. What’s unique about this effort is that the Pentagon wants a single contractor to lead the integration of a commercial electronic health records system to cover its nearly 10 million beneficiaries and large assortment of health care facilities worldwide. Defense is one of the largest health care providers in the country, on par in size with the Veterans Affairs Department and private sector leaders like Kaiser Permanente.

The article also states that they want to issue a contract with one vendor. We’ll see how that plays out. I’ve seen some rumors out there about who will be bidding. No doubt it will be a combination of the usual government contractors and EHR consultant companies together with EHR vendors like Epic and Cerner.

What’s going to be really interesting is the VA and its Vista EHR (Vista Evolution) is said to be bidding on the contract as well. We’ll see if they’re the only Vista bid or if others join in as well.

Here’s another great insight into the DoD EHR Contract:

Major data gaps in patient records occur when health care is delivered to beneficiaries outside the DOD network, and today approximately half of DOD’s 9.8 million beneficiaries receive their health care outside the network.

This was an obvious complaint of the AHLTA system. The DoD and VA couldn’t even get their EHR systems to be interoperable. I’m not optimistic that interoperability will be obtainable even under this new contract. That includes DoD to VA interoperability, let alone trying to connect with the care the DoD beneficiaries receive outside the DoD network.

I realize that nothing with the DoD health system is simple. Its an enormous system with all sorts of crazy government regulations. However, I’d hope for $11 billion, we could do better than we’re doing for our veterans.

At HIMSS, I talked with a largely military EHR vendor. They told me that they were close to being able to exchange records between different locations. That’s right. At HIMSS 2014 the amazing breakthrough was that 2 locations with the same EHR software were close to being able to exchange data.

DoD, VA Spent Bulk of 2012 iEHR Budget on Support Contracts

Posted on November 27, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The VA and DoD’s iEHR project may or may not come together, but it seems clear that at least one party is getting ahead — the vendors the agencies retained to support the project.

A new report from the Interagency Program Office concludes that the two agencies spent more than $300 million funding support contracts for iEHR work in 2012.  The IPO’s job is  to modernize the Military Health System’s EMR software.

DoD and the VA have been working to build a joint integrated EMR, known as the iEHR, since 2009. The idea is to build an EMR which allows every service member to have and maintain a single personal electronic health record through their career and lifetime.

However, to say the project has been troubled is an understatement, with changes of strategy riddling the effort throughout its lifespan.

In February, for example, the iEHR project was halted, with officials electing to make their current EMR systems more interoperable.

A few months later, DoD Secretary Chuck Hagel wrote a memo stating that the agency will consider a commercial EMR system. Most recently, the DoD asked 27 EMR vendors to provide demos of possible EMR replacements.

Most recently, the DoD announced that it was looking for contractors that can support its current EMR, AHLTA, through 2018.

All  I can say is that if you’re following all of this you’re way ahead of me. With so many switches in direction, I can’t imagine anything lasting and good coming out of the process. Maybe you have to be military to get it. As for me, I see a strategy process that seems to be governed by something resembling a coin flip.

DoD Official Says Agency *Might* Select VistA Derivative

Posted on June 20, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While it appears to be an outside shot, it’s possible that the Department of Defense might still consider a derivative of the VistA EMR for its VA EMR integration project, though a straight ahead VistA implementation sounds like it may be out of the question.

At a briefing by DoD, Under Secretary for Acquisition, Technology and Logistics Frank Kendall said that while using and modernizing VistA was a “reasonable decision” for VA, it’s necessarily as bright an idea for the DoD.

After doing market research, DoD technology leaders have decided that they’ll consider a mix of competing commercial products as well as Vista-based systems, and have taken in about 20 pitches from EMR vendors.

“Three of them were from VistA-based approaches, and the rest were from other approaches,” Kendall said. “So we think we have a rich field to pick from, and we can make a best value determination for DoD.”

When asked how much the DoD’s next EMR move is going to cost, Kendall did a bit of a bob and weave, saying that seamlessly integrated data is funded in the ’13 and ’14 budgets, without naming a number for those projects or long-term costs.

OK folks. You know what?  This whole thing really ticks me off — how about you?

I don’t know why the DoD is so dismissive of VistA, but despite its colossal failures with AHLTA and the death of the iEHR project, people there still seem to think they should pursue their own course rather than go with what’s been working at the VA.

And as an American taxpayer, much less a health IT analyst, I’m really tired of hearing the leadership at DoD justify their shaky moves in the EMR arena.

Come on, Mr. Kendall. Why won’t you be more specific about the costs of your health IT initiative?  Perhaps it’s because VistA-based products could cost 10 times less than, say, an Epic installation and you don’t want annoying editors like me bugging you about it?

Apparently even blistering critiques by your colleagues haven’t moved leaders like you off of your entrenched commercial approach to EMR integration.  I guess it’ll take a memo from on high — apparently one from President Obama doesn’t suffice — to get the generalissimos of HIT at the DoD to try something that might work.

EMR Data Deluge Means Missed Test Results

Posted on March 8, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In theory, the rich trove of information captured by EMRs supports patient care. But in practice, when the data gets overwhelming it can  have the opposite effect, according to a new study of primary care physicians within the VA system.

A group of Houston researchers, including the VA Health Services Research and Development Center of Excellence, surveyed almost 2,600 VA PCPs between June 2010 through November 2010, asking about their experience witih EMR-based alerts.

According to a report in Modern Healthcare, almost 30 percent of PCPs said they had missed notification of test results which then lead to care delays. (These results were presented in a research letter in the AMA journal JAMA Internal Medicine.)

Under the circumstances, it’s hardly surprising that doctors would sometimes lose track of EMR alerts. Respondents in the Houston study reported that they received a median of 63 alerts a day (no, that’s not a typo). Almost 87 percent of the PCPs surveyed thought that was an excessive level.

Aside from the sheer volume alerts, other reasons PCPs felt they missed test results included poor EMR usability and gaps in electronic handoffs of a patient’s record to another provider, Modern Healthcare reports.

The researchers behind the study argue that it’s time to adapt EMRs to allow for the safe handling of test result follow-up in EMRs.

I’d argue that this, for once, can’t be laid strictly on the doorstep of the EMR vendors.  Alarm fatigue of all kinds comes up as a major IT health risk over and over again when researchers take on the subject.  So even if EMRs had embedded a way to track and highlight abnormal test results intelligently, it won’t do much to lower the distraction level in hospitals generally.

This study is just one more alarm of its own, warning  us that even the best-rested, most-focused PCP is only human and can only adapt to so many interruptions.  Lowering alarm overload in hospitals generally, be it within EMRs or outside, clearly continues to be a critical issue for hospital IT leaders to consider.

DoD, VA Plan To Streamline EMR Integration Effort

Posted on February 12, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The Department of Defense and VA have decided to change the way they integrate their two EMRs, in an effort they say will lower the cost and speed the pace of interoperating.  The new approach is expected to offer at least partial functionality by 2014, rather than forcing the two agencies to wait until 2017, reports FederalNewsRadio.com.

Rather than sticking to their current course, which involves a massive effort to integrate their respective EMRs into a single system, health IT leaders will attempt to make more short term  progress.

To date, the DoD and VA have been working on common requirements and data standards and developing a shared enterprise service bus, all in the service of creating a single system. Agency leaders had estimated that the existing project would cost $4 billion.

The new plan, while keeping the larger goal of integrating by 2017, will include efforts to use existing solutions to get to interoperability quickly. Leaders expect their new direction to be considerably cheaper.

By the end of this year, the two departments will begin sharing a common UI, with the rollout beginning in seven DoD and VA wounded warrior polytrauma centers. Then, by  2014, the VA and DoD expect to be exchanging seven types of critical data, including lab results, clinical notes and allergies. The VA and DoD will accomplish this by standardizing the day their systems currently use, the VA’s chief information officer told FederalNewsRadio.com.

Another key component of the two agencies’ efforts is establishing a common system for identity management.  The identity management system is drawing on the massive Defense Manpower Data Center storehouse of personnel informaton operated by the DoD.

VA Plans Baseline Repository for VistA

Posted on December 28, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Right now, there are 133 instances of the VA’s popular VistA software operating across the U.S. In an effort to create some harmony, the VA has set plans to create a special separate repository for its Gold Disk version of VistA which developers can use as a baseline.

According to Healthcare IT News, the VA is also planning a software testing platform, open source dev standards and documentation of open source community outreach planning.

The idea behind the VA’s move is to attract more developers and code contributions to VistA, which despite its popularity is getting a bit long in the tooth at more than 30 years old, HIN reports.

VistA is already being renovated by the community managed by the Open Source Electronic Health Record Agent (OSEHRA), a not-for profit created by a previously standing contract between the agency and The Applications Informatics Group.

The group is working to create a minimum baseline standard for VistA code behind 20 key modules. To do that, OSEHRA’s working with VA’s internal development team to clean up the code and leverage what works.

Meanwhile, OSEHRA is working as a custodial agent is to certify open source code for integration into the VistA code base and to make sure complimentary software contributions will work with VistA.

According to estimates cited by HIN, OSEHRA should cost less than $10 million per year, while replacing VistA with an existing commercial EMR could cost about $16 billion. (Yeah, there’s a no-brainer for you.)

In any event, the big idea behind all of the VA’s VistA efforts is to get things moving quickly and bring on the innovation.  It’s hard to argue that this is a good idea. Whether OSEHRA itself is the right vehicle to guide and channel this innovation is anybody’s guess, but if it can harness the explosive creative force that is the open source community, watch out!

Vista was a Healthcare Application Before Being a Billing Application

Posted on December 7, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

VistA/CPRS (which is the provider portal) was developed as a healthcare application and later billing. This is unlike most of the ‘big guns’ in the US market. The success is in the ease of use and end-user functionality.

-Philip Foulis

I’ve long argued that one of the biggest issues with EMR software is that they were originally designed to be big billing engines. Their intent wasn’t to try and improve healthcare. Their goal was to try and improve and manage reimbursement. So, it shouldn’t be any surprise that many doctors aren’t satisfied with what EHR software offers them when it comes to providing care to patients.

Of course this is starting to change as many see EHR software as the opportunity to improve health care and to lower the costs associated with healthcare. It’s going to take time to make the shift.

With this said, the quote above is quite interesting to consider. Was Vista really designed with the provider and patient in mind first? Obviously the VA bills very different than other hospital systems and so they can focus on the care of their patients since it’s incredibly beneficial to them to do so. It would be interesting to look at Vista versus the other major hospital EHR companies to see how they differ in this regard.

Contest Offers Prizes For CCD Redesign

Posted on November 19, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

When EMRs are the gossip of the week at TechCrunch (a popular tech startup website), you know our little EMR thang has gone mainstream. And TechCrunch is indeed one of a series of sites trumpeting the news of a design challenge intended to make the Continuity of Care Document more usable.

The White House’s Health Design Challenge, working with a community of philanthropic angels and mentors known as Designer Fund, asks designers to transform the CCD (and by extension the Blue Button output) from a consumer-hostile mess into something easily used by the following groups:

  • An underserved inner-city parent with lower health literacy
  • A senior citizen that has a hard time reading
  • A young adult who is engaged with technology and mobile devices
  • An adult whose first language is not English
  • A patient with breast cancer receiving care from multiple providers
  • A busy mom managing her kids’ health and helping her aging parents

The ONC and VA, which seem to be spearheading the effort, are providing for twelve winners. First place for best overall design gets $16K, second place $6K and third place $4K. They’re also distributing $8K per category across winners for best medical/problem history section, best medication section and best lab summaries.

The design is expected to not only improve the visual layout of the record, it’s also supposed to make it easier for a patient to manage their health, enable medical professionals to digest information more efficiently and help caregivers support patients. Tall order for a messed-up text file?  Well, we’ll see what design superbrains can do.

In part because the VA hopes to use the new designs to support its Blue Button initiative and its MyHealtheVet patient portal, all entries have to be submitted under a Creative Commons license.   Curators will select a final design — which may include elements from various winning entries — and open source the code on code-sharing commuity Github.

New Open-Source GUI Can Display Multiple EMRs

Posted on May 30, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A non-profit focused on HIT has released an open-source graphical user interface which will provide a common view for patient information from multiple EMRs — a very useful trick if the software delivers what it promises.

The interface, Janus, was created as part of an interoperability program designed to link Department of Defense and VA data.  Right now, Janus is deployed at the VA Pacific Islands Health Care System/Triper Army Medical Center and clinics at James A. Lovell Federal Health Care System.

This seems like a great idea. If doctors in private medical settings could look at multiple EMR outputs at one time, I’m sure they’d be grateful.  After all, it can’t be much fun going from EMR to EMR as you travel from one hospital to another.

Such a unified view would probably save lives, ultimately, as it’d make it easier for doctors to quickly spot problems and review cases distributed across hospitals and clinics. Oh, and reduce doctor burnout too.

Though I’m a big fan of open source efforts, I’m sorry to say that I doubt it will make a dent in the way hospital IT departments and commercial EMRs are deployed.  Unfortunately, most vendors seem to feel they have more to gain by creating silos than making data sharing easy.

Still, it’s good to hear that the VA and DoD are doing something to interoperate. The two have been notorious for spending billions of bucks on integration projects that go nowhere, especially here in the healthcare arena.

The DoD’s AHLTA EMR project alone consumed 13 years and $2 billion, according to one account. The project went wrong due to poor planning and what sounds like arrogance (a failure to appreciate the “significant complexity” of the program), the Government Accountability Office concluded in 2010.