Our incompetent stewards for health IT interoperability

‘We took a broken system and just broke it completely’

By Arthur Allen
POLITICO, March 8, 2018

President Donald Trump last year hailed a multibillion-dollar initiative to create a seamless digital health system for active duty military and the VA that he said would deliver “faster, better, and far better quality care.”

But the military’s $4.3 billion Cerner medical record system has utterly failed to achieve those goals at the first hospitals that went online. Instead, technical glitches and poor training have caused dangerous errors and reduced the number of patients who can be treated, according to interviews with more than 25 military and Veterans Affairs health IT specialists and doctors, including six who work at the four Pacific Northwest military medical facilities that rolled out the software over the past year.

Prescription requests came out wrong at the pharmacy. Physician referrals failed to go through to specialists. Physicians were unsure how to do basic things such as request lab reports. Doctors complained it could take 10 minutes to get into the system, which then frequently kicked them out.

“We took a broken system and just broke it completely,” said one doctor, who like most of those interviewed requested anonymity because they lacked military authorization to speak about the project.

These and other problems, particularly concerns about the VA's ability to share records with civilian health systems, contributed to VA Secretary David Shulkin’s decision in December to delay signing a $10 billion contract to install Cerner at the VA.

Despite the startup issues, which have been glossed over in public discussion of the project, the White House continues to make the overhaul of the military and VA medical records a centerpiece of its government reform efforts.

"This was a huge win for our service," Jared Kushner told a health IT conference in Las Vegas on Tuesday, referring to Shulkin's decision last spring to use Cerner following consultations with Kushner's office. "The president wants to make interoperable health records available for all Americans."

But Kushner’s comments gave the impression the military had already created an electronic record system, and was just waiting for the VA to connect to it. In fact, the military’s MHS Genesis project, which started rolling out in February 2017, is still in the early stages, with completion scheduled for 2022.

And the tough experiences described by doctors and others suggest a thorny path ahead.

Efficiency promises notwithstanding, the new system has resulted in significant slowdowns so far, said physicians at the two hospitals that went live with MHS Genesis in September and October, respectively. At Bremerton, the system is so cumbersome and confusing that doctors who saw 18 to 20 patients a day now see 12 or 14, they said.

Shulkin’s decision to delay the contract won widespread praise, but critics bemoan his decision last year to shutter an internal program to modernize the VA’s existing digital record system, known as VistA. Many health IT experts left the agency after cancellation of the program, which involved hundreds of staff and contractors.

“We’re doing a once-in-a-lifetime replacement of an … [existing electronic health record system] that’s pretty functional — some of our physicians like it better than Epic or Cerner,” said a recently retired VA official. “Why replace it with something that’s basically the same?”


ONC chief Donald Rucker lays out his agency's very full plate

By Mike Miliard
Healthcare IT News, March 7, 2018

In an evening session at HIMSS18 on Tuesday, National Coordinator for Health IT Donald Rucker, MD, sat down for a candid talk about an array of issues related to federal healthcare policy.

On what makes interoperability so hard for healthcare:

What makes it hard is that you have to solve for multiple things at once. We have to solve simultaneously for just the physical wiring, the interoperability stack. We have to solve for the simple syntactic standards of data transmission. We have to come to some consensus for semantic interoperability: what was the meaning of what was transmitted. And then finally, we have to deal with the business case. And the business cases are hard to deal with because some of these cases are virtual things in the future, involving competitors, and business models that don't exist at the present. And if that weren't enough, we have to do it with privacy and security. That's what makes it hard.



By Don McCanne, M.D.

If we were to fulfill the dream of having immediate Internet access to any prior medical records throughout the nation, it was important that IT systems be interoperable. However, when David Brailer was appointed George W. Bush's first IT guru, he insisted that the systems be developed in the private sector, rejecting a proven system that we, the taxpayers, already owned - the VA's VistA system.

It was clear at the time that the private vendors did not want interoperability with any other systems than their own. Each wanted to become the dominant system, Microsoft-style, so that new purchasers of health IT systems would have to go with the dominant vendor to ensure interoperability. As it turns out, there are too many systems, and they are not interoperable. But the Trump administration is now claiming that they will bring interoperability to us, but through the private sector.

So what does the current IT guru, Donald Rucker, have to say about interoperability? He says, "we have to deal with the business case, and the business cases are hard to deal with because some of these cases are virtual things in the future, involving competitors, and business models that don't exist at the present." The business case.

In a speech at the same IT conference in Las Vegas this week, Jared Kushner is taking credit for the "huge win" for bringing in the private vendor Cerner to replace the VistA system, saying, "The president wants to make interoperable health records available for all Americans." Well the interoperability is intended to be between the military's health IT system and the VA system. He seems to assume that the military system being designed by Cerner is a given, but this report indicates that it has been a disaster and it has hardly even gotten off the ground. And that is going to be duplicated for the VA?

It's too bad because the VistA system was undergoing modernization when the new administration shut the process down (and lost hundreds of highly competent staff and contractors).

Insisting on private sector solutions for interoperability has been a disaster, just as the private sector has been a disaster in financing of our health care system when a public single payer system would be vastly superior. Is Trump going to put Jared in charge of further privatizing our health care financing? Can hardly wait.

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