VA Leaders Says Decision on Cerner EHR Acquisition Coming in Next Two Weeks | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

VA Leaders Says Decision on Cerner EHR Acquisition Coming in Next Two Weeks

May 10, 2018
by Heather Landi
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Robert Wilkie, the acting secretary of the U.S. Department of Veterans Affairs, will make a decision on whether to move forward with an acquisition contract with Cerner for a new electronic health record (EHR) system by May 28, Memorial Day, according to VA leaders.

During a Senate appropriations subcommittee hearing on Wednesday, Jon Rychalski, assistant secretary for management and chief financial officer at the VA, provided lawmakers with an update on the timeline for the EHR procurement. The hearing was focused on the VA’s Fiscal Year 2019 budget request. During the same subcommittee hearing, several lawmakers raised concerns about what they called a “leadership vacuum” at the VA and the ongoing delays with the EHR acquisition contract.

“[Wilkie] has said he is going to make a decision by Memorial Day,” Rychalski told lawmakers Wednesday, adding that Wilkie “came in cold” with regard to the VA’s EHR modernization. “He knew what was going on with DoD but not enough about the VA, and he wanted to do due diligence to make sure he was comfortable in making a decision of this magnitude. So that’s the reason for the second delay. Before that they were looking at the contract and interoperability and that was probably worthwhile because they came up with about 50 recommendations to improve it.”

In an emailed response, VA Press Secretary Curt Cashour said, “Finalizing a decision on the Department’s electronic health record modernization (EHRM) effort is one of Acting Secretary Wilkie’s top three short-term priorities for VA, given the importance, magnitude and financial investment that this decision represents for Veterans and the department.”

Further, Cashour said, “While VA doesn’t typically comment on ongoing contract negotiations, proper due diligence is required to ensure the best interests of Veterans and taxpayers are served before the department enters into any agreement of this size and importance. We are doing that now, and expect to make a final decision and corresponding announcement on EHRM in the coming weeks.”

It’s been almost a year since the VA announced that it will replace its aging EHR system, called VistA, by adopting the same platform as the U.S. Department of Defense (DoD), a Cerner EHR system. Since then, senators have pushed the agency for a timeline for the EHR project and for plans to ensure that the technology systems of the VA and DoD will be integrated. During an October House Committee on Veterans’ Affairs hearing, Shulkin told lawmakers that it will be seven or eight years before Cerner's EHR system is fully implemented throughout all VA locations.

In March, President Donald Trump dismissed VA Secretary David Shulkin, M.D., and, at that time, negotiations between VA and Cerner were delayed. In December, Shulkin announced “a strategic pause” in the EHR acquisition process, with the purpose being to conduct an assessment of national interoperability language contained in the Request for Proposal that would ultimately support an EHR contract award. MITRE Corporation would be conducting the external assessment and Shulkin said earlier this month that MITRE provided the VA with 51 recommendations, and that the agency was building these into the contract with Cerner.

Trump nominated Ronny Jackson, M.D., White House physician and rear admiral in the Navy, to serve as VA Secretary, while naming Wilkie the agency’s acting secretary. However, Jackson withdrew due to allegations around his professional conduct. A number of top VA leaders have left since Shulkin’s ouster. Scott Blackburn, the department’s acting CIO, announced his resignation in April. As CIO, Blackburn was in charge of VA’s Office of Information and Technology and one of his top projects was replacing VA’s VistA EHR with the same platform as the DoD, a Cerner EHR system.

Senator Brian Schatz (D-Hawaii), ranking member of the appropriations subcommittee, said during Wednesday’s hearing, “I’m concerned that no amount of money from Congress can fix the leadership issues at VA. The department is losing qualified professionals, seemingly by the day, and that includes Scott Blackburn, the person overseeing the EHR transformation, who quit in mid-April,” he said. “If news reports are to be believed, political appointees have no interest in listening to career VA professionals, who are there to help them do their jobs. This is turning into a crisis for our veterans and the 360,000 employees who serve them every day.”

Schatz further said, “There needs to be leadership, trust, collaboration, accountability and stability, all of which are currently lacking. I hope with Congressional oversight, the VA can find its footing again.”

Late last year, the VA submitted a formal request to congressional appropriators to reprogram $782 million of Fiscal Year 2018 funding to kick start its planned procurement of the Cerner EHR. The VA’s FY2019 budget request includes $1.2 billion for EHR modernization. According to the latest data provided to Congress, it will cost the agency a total of $15.8 billion over 10 years to implement the system, Reports have surfaced that the contract will be in the $10 billion range, making it one of the largest health IT implementations in history. However, other reports have put the total figure in the $15 to $16-billion-dollar range.

During the hearing, Schatz also questioned the need to appropriate another $1.2 billion when the contract was currently not moving forward. “The VA has taken steps to overhaul EHRs and Congress has supported those steps. We see the wisdom in buying the same system as DoD, and we provided funding to the VA to get the system online, but the process has stalled, in part because of the leadership vacuum at VA, contracting delays and, finally, the need to align the VA and DoD roll out, if it’s going to be the same system,” he said, continuing, “ I don’t understand that if VA hasn’t spent the hundreds of millions of dolllars that have already been appropriated for this new system, then why would VA then request $1.2 billion on top of it. We have a fixed amount of money in our allocation and it makes little sense to give the VA more money for the EHR system, so it can sit in an account while this all gets sorted out.”

In response to questions about the requested funding, Rychalski’s comments during the hearing implied that the VA would be moving forward on an EHR acquisition in the near future. He explained that a “substantial amount,” about $1.1 billion, would go to the prime vendor, although Cerner was not specifically named, and the balance would be for infrastructure and equipment. According to Rychalski, there is a three-year period of availability for the reprogrammed funding of $782 million. “We’re not going to use all of the $782 million this year, but $160 million will carry over to next year. There is a plan for it and we are projecting the need,” he said.

Rychalski also said, “We don’t anticipate a substantial delay with the first increment of this," and then added, "We owe you a deep dive into the funding for 2018 and 2019 and explaining our trajectory.”

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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.

 

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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.

Webinar

Driving Success at Regional Health: Approaches and Challenges to Optimizing and Utilizing Real-Time Support

Regional Health knew providing leading EHR technology was not the only factor to be considered when looking to achieve successful adoption, clinician and patient satisfaction, and ultimately value...

About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.

 

 

 


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