How will negotiations unfold? The VA will forgo an open bidding process as Shulkin says the VA doesn’t have time to wait another 26 months that it took its Defense counterparts to settle on Cerner. That means Cerner has the upper hand in talks with the VA since they’re the only ones the VA seems interested in dealing with. Shulkin admits Cerner’s system will cost more than the initial $4.3 billion the DoD paid. The VA has 137 medical centers and thousands of clinics nationwide compared to DHS’s 55 domestic hospitals. Costs and an implementation plan will take three to six months to develop, Shulkin said.
Is making a Cerner-to-Cerner connection that easy? Multiple EHR vendors Morning eHealth Shulkin isn’t aware of the complexities of exchanging information between two hospitals using the same EHR. Furthermore, the VA will need a platform to allow information to flow between the VA, DoD and civilian health care providers, a priority for Shulkin and the VA. “We must move beyond individual, siloed software systems to a platform approach where IT systems can coexist and foster collaboration,” Kyle Armbrester, athenahealth’s chief product officer, told us.
Who will partners be? Cerner made its pitch to the DoD with partners Leidos and Accenture. But NextGov says it’s likely the VA will either issue a direct contract to Cerner with freedom to award subs or the VA will hold an open competition for integrators.
Will DoD’s rollout even be OK? Cerner’s initial work with the DoD has already been delayed before work has really gotten started. Shulkin called the DoD’s first installation at an Air Force base in Washington state “successful.” But an installation at a base in Oak Harbor, Wash., which was scheduled to start in December, was pushed back to this summer.
— A VA spokesman says Chris Miller, who at one time ran the DoD’s Cerner implementation before retiring, has been working with the VA along with Navy Capt. John Windom, who led the acquisition of Cerner while at the DoD.
— Arthur Allen has much more detail for Pro subscribers, including more comment from skeptics. Find Shulkin’s press conference at the VA and White House or read the transcript for what he had to say.
CONGRESS LIKES THE MOVE: Lawmakers were unanimous in their praise for the decision. Glowing statements came from House Majority Leader Kevin McCarthy, Veterans Affairs committee chairs Phil Roe and Johnny Isakson and Senate Armed Services Committee Chair John McCain. But House Appropriations Chair Rodney Frelinghuysen said his panel “has demanded that the Departments of Veterans Affairs and Defense use an identical or at least compatible or interoperable network.” This fulfils that request.
What Trump had to say: “No more complications. The records will now be able to follow the veteran when they leave service — meaning faster, better, and far better quality care,” the president said Monday. “Of course, there is still much work to do, but today’s action shows the determined leadership and what it can accomplish — great, great reform.”
— Shulkin credited the White House Office of American Innovation for helping to drive a switch from VistA to Cerner by instilling a mandate “to do things differently,” but the ultimate decision was all Shulkin’s.
eHealth tweet of the day: Dr. David J. Shulkin @SecShulkin: .@DeptVetAffairs’ adoption of the same EHR system as @DeptofDefense will ultimately result in all patient data residing in one common system
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DISPATCH FROM APPLE DEVELOPER CONFERENCE: Users of the Apple Watch will soon be able to link their devices to a glucose sensor from Dexcom, the tech giant said Monday at its annual developer conference in Northern California. The advance is made posible by a new bluetooth API that will allow others in the future to connect with the Apple Watch and build other health sensors, each embedded into interchangeable watch bands. Other companies are developing technologies that will track a user’s heart rate and symptoms for stroke, CNBC’s Christina Farr reports. Dexcom’s stock price jumped more than 5 percent off the Apple news.
Where’s the FDA in all of this? Bradley Merrill Thompson, general counsel of the Clinical Decision Support Coalition: “According to the 2015 mobile medical app guidance document from FDA, the agency had already declared as enforcement discretion mobile apps that track and trend health data, but the SOFTWARE Act [signed into law last year as part of 21st Century Cures] clarified that FDA actually has no regulatory authority over such software. In the eyes of many developers, that's much better than simply FDA promising to use enforcement discretion.”
Other updates from the Watch: The device will exchange data with gym equipment, such as heart rates and treadmill incline. More personalized activity notifications will let users know when they’re close to hitting activity goals.
WHAT ABOUT THE COAST GUARD?: Lost — but not to us — in the wake of the Veterans’ Affairs EHR decision are the effects on the Coast Guard. It’s still stuck on the most primitive medical record of all — paper. After the announcement, Michael Little, the director of legislative affairs for the Association of the U.S. Navy, dashed off a letter to the congressional Coast Guard Caucus asking them to advocate for putting the Coast Guard on the VA and DoD’s platform. “I’m not sure what would be more of an emergency [than paper records],” Little said. “It’s just common sense to have all of the branches of the military” on the same system.
COMING LATER THIS WEEK: As expected, the House Energy and Commerce Committee announced it’ll mark up its FDA user fee bill Wednesday morning, the panel announced late Monday. The Senate HELP Committee last month approved its package, which will expand the FDA’s digital health work.
THIS RANSOMWARE ISN’T GOING AWAY, AND IT MAKES ME WANT TO CRY: The WannaCry malware, which swept the globe last month and took the U.K.’s National Health Services offline, continues to hit two, large, multi-state hospitals systems, according to HHS. In a note sent on ONC and OCR list serves, the government warns the virus can persist even on computers than have been patched, but the virus won’t spread on patched computers. However, attempted hacks by WannaCry can disrupt Windows.
AMA TO TACKLE PDMPS AT UPCOMING MEETING: The nation’s largest medical group wants better interfaces between EHRs and state-run prescription drug monitoring databases as well as better data on how using such databases prevent opioid-related harm and deaths. Also among the many topics to be discussed at next week’s American Medical Association meeting in Chicago is urging VA pharmacies to report PDMP data to state databases.
Also on the table: Tennessee delegates want the AMA to work with tech companies to develop HIPAA-compliant platforms that better allow for texting between patients and their doctors. Also a Board of Trustees report on the use of medical scribes will revive debate about training and oversight.
Incoming AMA President David Barbe tells a Florida newspaper that “paperwork hassles” and constant bureaucratic obstacles are leading to physician burnout.
MORE DATA-SHARING: Time to start planning, investigators. In a new editorial published in the New England Journal of Medicine, authors representing the International Committee of Medical Journal Editors — a group that represents all the research paper heavyweights — have announced they’re asking authors to append a data-sharing plan. That plan will need to include details like: will deidentified participant data get shared, and what terms and to whom the data will get shared, and so on. The plan applies for all papers submitted after July 2018.
“We envision a global research community in which sharing deidentified data becomes the norm,” the authors declare.
WHAT WE’RE CLICKING:
A class-action patient privacy lawsuit against MDLive was abruptly dismissed just one month after it was filed, “without any monetary settlement by MDLive,” MobiHealthNews reports.
By avoiding FDA regulation or insurance coverage, Silicon Valley is avoiding populations who would benefit the most from novel products, Christina Farrwrites.
Are HHS’s cyber task force recommendation’s doable?
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