Is $9B Cerner deal good for DoD?

July 30, 2015 in Medical Technology

It might seem like a bit of Monday morning quarterbacking, but industry insiders are weighing in on the $9B contract the Department of Defense signed with EHR giant Cerner, and some are suggesting the government could have finessed a better play. 

Indeed, the announcement comes at the same time that Congress and the Administration are heavily invested in finding the answer to the question: How is it that most of the systems in use today still don’t talk to each other after $30 billion being invested?

“At the front end, it strikes me as unfortunate and puzzling that we’re about to put another $10B – conservatively – into one of the very systems responsible for the supposedly unacceptable status quo,” Dan Haley, vice president, government and regulatory affairs at cloud-based health IT company athenahealth, told Healthcare IT News on Wednesday, hours before DoD announced its selection.

[Related: EHR go-live gone wrong.]

To Haley, that reaction was not particular to Cerner, Epic or Allscripts, the three contenders left in the running for the 10-year government contract. Regardless of the vendor, he said, it calls to mind the old insanity saw about repeatedly doing the same thing and expecting different results.

“The finalists are all very good, very credible purveyors of data software systems that aren’t very good at exchanging information outside of their platforms,” he added. “Not because they don’t want to be, but because they’re not built for that. They’re pre-Internet platforms. They were literally created to share information within the confines of a closed network. And now they’re jerry-rigged to share information outside themselves.”

That, he says, is an expensive proposition and Haley has some influential company to bolster his position.

Back in February the Center for New American Security released a report that urged DoD to choose an open-source EHR system that would be “extensible, flexible and easy to safely modify and upgrade as technology improves and interoperability demands evolve.”

“DoD is about to procure another major electronic (health records) system that may not be able to stay current with – or even lead – the state-of-the-art, or work well with parallel systems in the public or private sector,” the authors wrote. “We are concerned that a process that chooses a single commercial ‘winner’, closed and proprietary, will inevitably lead to vendor lock and health data isolation.”

The authors of the report urged DoD to show some leadership.

“We believe that, like in so many other aspects of our society, DoD could play a leadership role,” they wrote. “It could catalyze expectations, model behavior, and deliver measurable outcomes far outside its five walls. Nowhere is this more true, more necessary, and more far-reaching than the modernization of healthcare services.”

Retired Army Gen. H. Hugh Shelton, Stephen L. Ondra and Peter L. Levin wrote the report.

Shelton, a former chairman of the Joint Chiefs of Staff, and is now the chairman of RedHat Software. Ondra is a former senior advisor for health information in the White House Office of Science and Technology Policy, and is today senior vice president and chief medical officer of Health Care Service Corporation. Levin is a former CTO at the Department of Veterans Affairs, and currently the co-founder and chief executive officer of Amida Technology Solution.

The DoD’s request for proposals precluded a bid from athenahealth or similar cloud-based companies, Haley said. The so-called “gating criteria” made that clear by “using the term ‘best of suite solution,’ which our contracting people told us was code for single platform, which means static software.”

He also noted that a team led by PwC that included Google and open-source software company Medsphere was knocked out of the competition after the first round of review.

“How is it that in 2015 anyone thinks it’s rational to contemplate a 10-year implementation of a piece of software?” he asked. “Think about the rate at which this kind of technology evolves. The proposition that it will be obsolete before it’s fully implemented is not a guess. It’s a certainty.”

Related articles: 

Ready for the next generation of EHRs?

DoD EHR modernization set to rock marketplace

Is DoD EHR modernization destined to fail?

One out, three bids left for DoD EHR

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CVS Health, IBM Partner To Develop Care Management Technology

July 30, 2015 in News

On Thursday, CVS Health and IBM announced they are partnering to bring IBM’s Watson technology to CVS Health pharmacists and practitioners in an effort to improve health care management for patients with chronic diseases, USA Today reports. 

Background on Watson Technology

IBM’s Watson computing system can:

  • Analyze large amounts of information;
  • Develop knowledge over time; and
  • Interpret and evaluate data.

In addition, Watson can access:

  • Health records;
  • Pharmacy information; and
  • Other resources that allow CVS Health employees to help patients and work with primary care physicians.

Details of Project

For the collaboration, IBM and CVS will leverage IBM Watson Health in a way that lets providers and researchers use data and technology collected by the computing system to provide improved health care. The partnership also will use IBM Watson Health Cloud, which collects various data, including information on nutrition, medical history and lifestyle (Calfas, USA Today, 7/30).

Using the Watson technology, the companies aim to develop a system that can:

  • Predict health declines for conditions, such as diabetes, heart disease and obesity;
  • Prevent costly and unnecessary interventions; and
  • Provide more personalized care.

CVS Health CMO Troynen Brennan said the first stage of the project will involve creating and testing algorithms to determine if they improve patient outcomes. He said he hoped to see “realistic interventions” in one to two years (Eunjung Cha, “To Your Health,” Washington Post, 7/30).

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The good, the bad and the ugly: social media’s response to DoD Cerner EHR win

July 30, 2015 in Medical Technology

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Study: Telemedicine Effective for Providing Talk Therapy to Vets

July 30, 2015 in News

Telemedicine can be just as effective as in-person visits for delivering talk therapy to older veterans with depression, according to a study published in The Lancet, Reuters reports.

Study Details

For the study, researchers divided more than 200 veterans over age 58, who were diagnosed with major depressive disorder into two groups.

Both groups received identical behavioral activation treatment in four to eight one-hour therapy sessions. However, one group received the therapy during in-person sessions, while the second group received care in their homes using video conferencing technology to connect remotely with therapists.

Patients’ progress was measured using questionnaires in which the veterans rated their symptoms. Later on, researchers also used structured clinical interviews to gauge progress.

According to Reuters, patients whose symptoms were reduced by at least half were considered to be responding to treatment (Kennedy, Reuters, 7/29).

The study was conducted between April 1, 2007, and July 31, 2011 (Egede et al., The Lancet, August 2015).

Study Findings

Overall, lead study author Leonard Egede said the talk therapy “works for depression whether you deliver it by face-to-face or [via] the telemedicine approach.”

Specifically, the study found that:

  • After one month, 5% to 7% of patients in the telemedicine group reduced their symptoms by half, compared with 15% on the in-person visit group;
  • After three months, 15% of telemedicine patients reduced their symptoms by half, compared with 19% of in-person visit patients;
  • After one year, 19% to 22% of telemedicine patients reduced their symptoms by half, compared with 19% to 21% of in-person patients; and
  • After one year, 39% of telemedicine patients reported no longer being depressed, compared with 46% of in-person patients.

Egede noted that telemedicine can be helpful for older individuals who face barriers to accessing mental health care, such as limited mobility, stigma and geographic location.

Editorial Raises Safety Concerns

In an accompanying editorial, Charles Hoge, a psychiatrist and senior scientist at the Walter Reed Army Institute of Research, said that therapy delivered via telemedicine could raise safety concerns because there are no professionals on site to help in the event of an emergency.

In an email to Reuters he noted that while telemedicine “can expand patients’ options for receiving needed mental health treatment,” the “most important consideration is ensuring that there are procedures in place to address emergencies, such as if a patient reports intent to commit suicide or homicide” (Reuters, 7/29).

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Cerner data sharing may have been difference-maker

July 30, 2015 in Medical Technology

As it happens, it appears that the smallish contract awarded to Cerner to replace the Military Health System’s anatomic pathology lab technology earlier this month was a hint, after all.

Just weeks later, the Kansas City-based behemoth landed the big prize (although, at an initial value of $4.4 billion, not quite as big as the $11 billion many were first expecting). So what was it that gave Cerner the edge over longtime rival Epic system? A perceived commitment to interoperabilty is almost certainly a big reason.

Fair or not, Cerner’s reputation in recent years has been one of increasing embrace of openness – at least more open than Epic, which felt compelled this past year to hire a lobbyist to help counter the narrative that it doesn’t play well with others.

Whatever the initial motivations for Cerner’s founding membership in the CommonWell Health Alliance, for instance, its close work with Allscripts, athenahealth and other vendors makes it hard to argue that it isn’t at least trying to enable the freer cross-platform data sharing so essential to better care coordination and population health.?

For another example, the company “is a major participant in the DirectTrust network that links over 40,000 health care organizations and nearly a million individual private sector health care professionals via Direct exchange,” said David Kibbe, MD, President and CEO of DirectTrust, in a statement supplied to Healthcare IT News. “Cerner has been a very strong proponent of open, standards-based approaches to EHR interoperability.”

[Related: Is DoD EHR modernization doomed to failure and obsolescence?]

“Cerner’s demonstration of wide-ranging provider interoperability on multiple, different platforms were the huge differentiator over Epic’s garden-walled methodology to system user data sharing,” said Doug Brown, managing partner of Black Book, in another emailed statement on the DoD’s decision.

“The message on progressive provider connectivity should also serve as the strategic government directional to the entire EHR sector,” he added. “That closed off systems is objectionable for the greater goal of improving national patient quality and access to records anywhere.”

In an interview with Healthcare IT News earlier this year, officials from Leidos, the government contractor that will be now working alongside Cerner for the next decade-plus, said commitment to data liquidity would have to be a key capability of the eventual contract winner.?

A key component of the Pentagon’s RFP was that the system protect DoD from any eventual “data lock” or “vendor lock” in the years ahead, said Jerry Hogge, deputy group president of Leidos’ Health Solutions.

“This is a 10-year program,” he added. “So one of the very few amendments that the government made along the way was to have the vendors demonstrate how their solution would accommodate removing a module or integrating a new one, or adding a new modular capability.”

The hope, of course, is that the sheer size of this project – 9.5 million beneficiaries in the DoD system – means it can only have an impact on the rest of the healthcare ecosystem.

The initiative’s vast, worldwide scope means “there will be information technology requirements that bleed over into the commercial side of the industry,” Leidos Chief Medical Officer Carl Buising, MD, told Healthcare IT News. “I think what we will see is an advance in the overall information sharing capability and an advance in interoperability.”

Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, more or less confirmed that that will be the case in a recent interview with CNBC. The Defense Healthcare Management System Modernization “allows us to pivot toward the future – but also forces others to pivot toward the future,” he said.

“We’ve got to force the private sector to be able to exchange information in a very efficient way, in a very timely way, so we can get better outcomes for those beneficiaries,” said Woodson.

Related articles: 

DoD EHR modernization set to rock marketplace

EHR go-live gone wrong

One out, three bids left for DoD EHR


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DOD Selects Cerner Team for Massive EHR Overhaul Contract

July 30, 2015 in News

On Wednesday, the Department of Defense announced that electronic health record vendor Cerner, Leidos, a government systems integrator,  and Accenture Federal have been awarded its EHR modernization contract, FierceEMR reports (Bowman, FierceEMR, 7/29).


In February 2013, DOD and Department of Veterans Affairs officials announced plans to halt a joint integrated EHR, or iEHR system, and instead focus on making their current EHR systems more interoperable.

In August 2014, DOD issued a final solicitation for bids for the Defense Healthcare Management Systems Modernization contract, which was estimated to be worth $11 billion. A team of DOD civilians, military personnel and subject matter and procurement experts evaluated the proposals.

In addition to the Cerner team, other groups competing for the contract included:

  • A team that includes Computer Sciences Corp., a defense contractor and systems integrator, Hewlett Packard, a computer services firm, and EHR developer Allscripts;
  • A team that includes IBM and EHR vendor Epic, which recently unveiled a new advisory group; and
  • A team that includes DSS, General Dynamics Information Technology, Google, MedSphere and PricewaterhouseCoopers (iHealthBeat, 2/24).

Contract Details

The initial two-year contract is worth $4.3 billion. There are two additional three-year option periods and a potential two-year award term, which could bring the contract period to 10 years. In a release, Frank Kendall — undersecretary of defense for acquisition, technology and logistics — said the total contract value is now estimated to be $9 billion.

As part of the contract, the winning group will be responsible for upgrading and managing the health records of more than 9.5 million DOD beneficiaries (Conn, Modern Healthcare, 7/29). DOD officials said the system will be deployed at about 1,000 sites in the U.S. and abroad, including the DOD’s 55 hospitals and more than 600 clinics.

Christopher Miller, the Defense Healthcare Management Systems program executive officer, in a statement, said that the new EHR system will replace up to 50 legacy systems, each of which has its own transition plan (DOD release, 7/29).

Therefore, officials said the system will be implemented over six or seven years. Officials said they will begin deploying and testing the system at eight military facilities in the Pacific Northwest, which are expected to be up and running by the end of 2016 (Modern Healthcare, 7/29).


In an emailed statement, athenahealth CEO Jonathan Bush expressed disappointment that DOD did not go with a more open, Internet-based platform. He said, “By partnering with the very same legacy [health IT] system vendors [that] are largely responsible for the current state of disconnected health care, the DOD is making a long slog toward the type of interoperable infrastructure the [Office of the National Coordinator for Health IT] mapped out in its 10-year plan” (athenahealth statement, 7/29).

Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, said, “My biggest worry isn’t that Cerner won’t deliver, it’s that DOD will suck the lifeblood out of the company by running its management ragged with endless overhead and dulling the innovative edge of its development teams.” He added, “There is a tremendous amount of innovation going on in health IT right now. We need a well-performing Cerner in the private sector to keep pushing the innovation frontier” (Tahir et al, “Morning eHealth,” Politico, 7/30).

Todd Cozzens — venture partner and senior adviser at venture capital firm Sequoia Partners — said, “The number one focus of the DOD, the ONC and others should be, not only is this system useful, but can it interoperate” with other vendors’ EHRs. He added that he would not be surprised if the award is appealed (Modern Healthcare, 7/29).

According to “Morning eHealth,” Computer Sciences Corporation, which was on a bidding team with EHR vendor Allscripts, said it would “evaluate its options.” The IBM and Epic bidding team did not comment on the possibility of an appeal.

Meanwhile, John Halamka, CIO at Beth Israel Deaconess, appeared more optimistic, saying, “Cerner is a strong company, which has accelerated its interoperability and cloud hosting efforts over the past few years. Their strategic direction seems well-aligned with DHMSM needs” (“Morning eHealth,” Politico, 7/30).

According to MedCity News, Cerner is unable to comment on the announcement due to a mandatory quiet period that is expected to be lifted on Tuesday ahead of its scheduled earnings announcement for the quarter that ended June 30 (Versel, MedCity News, 7/29).

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When a cyber attack hits: Who’s in charge?

July 30, 2015 in Medical Technology

The dangers of data breach make for great headlines: data held for ransom, financial fraud, and medical identity theft, to name a few. But despite the many risks of data breach, from a business standpoint, the most immediate threat in most security incidents is failure to comply with regulatory requirements. The vast majority of security incidents don’t turn into data breaches, and not all breaches result in theft or other damages. But failure to report or meet other regulatory requirements can result in stiff penalties regardless. Therefore, incident response processes should be organized not only to address data security but also how best to determine whether an incident is a notifiable breach.

It takes a combination of specialties to handle a data security incident in a way that fully protects the organization. Assessing whether a data breach has occurred or not requires both data security and compliance expertise. Unfortunately, in most businesses, the information security, privacy, compliance and other organizations don’t work together fluidly to respond to an incident, leaving the organization vulnerable on the compliance front. A highly effective organization will define parallel paths for incident response very early in the discovery process. This not only enables accurate assessment of the incident from both the information security, compliance, and risk standpoints, it also positions each functional team to provide effective response and risk management throughout the entire lifecycle of the incident, whether or not it is determined to be a breach.

There are some immediate actions that privacy and IT/information security can take together to close the compliance gap. Since the IT/information security team is, by definition, the first responder to a data security event, the first step is to change their policies and operating procedures so that every incident is assessed not only from the security side but also from the compliance viewpoint. There should be:

  • A policy to notify the privacy/compliance team as soon as an event is suspected to be an incident, so they can begin a parallel evaluation into the pertinent compliance requirements.
  • A procedure for promptly and visibly notifying the compliance team and other potential stakeholders. (There must be no risk of a notification getting lost in someone’s email inbox).
  • A vehicle for documenting and handing off all of the information needed for the compliance evaluation: What data was touched, how much, whose, etc.? (This will also save time in the compliance process if notification turns out to be necessary.)

Catamaran, a company that provides pharmacy benefits management services to healthcare organizations, functions as both a HIPAA covered entity and as a business associate. When Catamaran implemented incident management software and trained its staff in risk-based incident response, the number of reported incidents went up because the software automates the process of evaluating incidents against the whole matrix of current state and federal regulations. Catamaran discusses its approach in a recent webinar, Bringing Incident Response Breach Management Out of the Dark Ages.

The focus on thriller-worthy cyber-security threats can distract from the day-to-day, yet critical needs of compliance and risk management. It can also divert funding and organizational clout from foundational privacy and security hygiene, and many organizations are beginning to integrate privacy/compliance and information security to ensure better collaboration and a focus on more than just technology. Security blogger Matt Kelly recently compared this more integrated approach to preparing for a heart attack: “You can go through life equipped with tools to reduce that risk, such as a defibrillator, and it will indeed help when the time comes. Or you can improve your process of being healthy: eating right and exercising. Neither one of those procedures will assure that you never have a heart attack—but they will help you immensely in staying alive should a heart attack come to pass.”

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Burwell: HHS Not Aware of Any Fraud in Federal Insurance Exchange

July 30, 2015 in News

On Tuesday, HHS Secretary Sylvia Mathews Burwell testified before Congress that her department has no evidence of consumers fraudulently obtaining coverage through the federal online health insurance exchange, Modern Healthcare reports (Dickson, Modern Healthcare, 7/28).


A Government Accountability Office report released  this month found that the federal exchange automatically re-enrolled 11 fake U.S. residents in health plans for 2015, despite ongoing documentation issues with the staged individuals. The initial investigation discovered that GAO officials were able to obtain subsidized coverage for fake applicants in 11 out of 12 applications submitted through’s website or the telephone.

A GAO official said during a hearing earlier this month that the agency did not find any proof of an individual fraudulently enrolled in federal exchange coverage outside of their investigation (iHealthBeat, 7/17).

Details of Burwell’s Testimony During a House Education and the Workforce Committee hearing, Burwell said GAO’s investigation is “the only examples (of fraud) that we know of.” 

According to Burwell, in the first quarter of this year HHS removed 117,000 people from the federal exchange and reduced the subsidies of thousands more after they were unable to verify their submitted information. Burwell could not say if any of those individuals were attempting to defraud the system. Further, Burwell said GAO has not issued recommendations to HHS regarding the results of its investigation.

Meanwhile, Senate Finance Committee Chair Orrin Hatch (R-Utah) in a letter to CMS acting Administrator Andy Slavitt requested details on data verification processes for the exchanges (Modern Healthcare, 7/28).

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MedSphere, ProSphere partner on VA work

July 29, 2015 in Medical Technology

Medsphere, an open source electronic health record company whose technology is based on the U.S. Department of Veterans Affairs’ VistA EHR, is partnering with contractor ProSphere Tek to work on a new VA project.

The work calls for developing  File Manager – known as FileMan – version 23. VA VistA’s core data management utility, enables the operation of VistA applications and modules, all working with integrated data.

Medsphere will focus specifically on enhancing FileMan to develop VistA’s fundamental data architecture and internal data management.

“We appreciate the trust both ProSphere and VA have shown in Medsphere’s VistA experience and expertise, especially with regard to FileMan,” said Medsphere President and CEO Irv Lichtenwald. “Medsphere has significantly enhanced FileMan for use outside the VA, and we contributed that version of FileMan to the Open Source Electronic Health Record Alliance, making it available to non-federal hospitals who want to affordably improve care.”

[See also: Medsphere makes big merger move.]

The VA has made clear that upgrades to FileMan are only one project in a much broader multi-year VistA modernization effort. Over time, VistA will be upgraded and made interoperable with the EHR system soon to be selected by the Department of Defense. (Medsphere was initially one of the vendors vying for that $11 billion DoD contract, in partnership with PwC, but was dropped from the running earlier this year.)

Interoperability and system improvements are intended to enable seamless medical records transfer as American military personnel move from the Military Health System to the Veterans Health Administration.
Medsphere is also currently working with Hewlett-Packard to test and remediate FileMan enhancements developed at the regional level in VA’s Veterans Integrated Service Networks That version, FileMan v22.2e, will soon be moved from class 3 to class 1 enterprise software as a result of the project and will be implemented as the core of VistA in all VA hospitals and clinics until FileMan 23 is completed and fully implemented.

[See also: BT bets on Medsphere’s ‘open’ EHR.]

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AHA Urges Congress To Improve Interoperability, Data Sharing

July 29, 2015 in News

Last week, the American Hospital Association sent a letter to Congress urging lawmakers to strengthen policies that will support interoperability and health data exchange, Health IT Security reports.

Letter Details

In the letter, AHA noted that many of the electronic health record systems used by hospitals and health systems:

  • Cost too much and are too complex to be sustainable;
  • Do not easily share data; and
  • Do not provide universal access to infrastructure, such as efficient exchange networks (Snell, Health IT Security, 7/28).

AHA outlined several recommendations aimed at improving interoperability, such as:

  • Conducting more pilots and demonstrations to test standards that support interoperability and ensure standards have clear implementation guidance before being included in federal regulations; and
  • Enacting policy changes that will “hold vendors accountable for the design and marketing of interoperable products” (AHA letter, 7/23).

However, AHA warned against adding additional policy drivers intended to encourage providers to share health data. AHA said such drivers would be unnecessary or even harmful “if they become overly prescriptive or contradict the larger set of payment incentives and quality initiatives in place.”

AHA added, “Similarly, heavy-handed sanctions on providers for failure to share information would be duplicative of the meaningful use requirements to share health information and could have unintended consequences.”

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

AHA also noted that Congress currently is considering cybersecurity issues and urged lawmakers to keep in mind that the health care industry already has federal statutes and regulations in place that govern information security, such as HIPAA.

AHA wrote, “The AHA strongly believes that improving the infrastructure to support secure data sharing in support of clinical care can be accomplished within the existing HIPAA requirements and the existing framework of cybersecurity policy” (Health IT Security, 7/28).

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