Today, many people are unable to get tested for diseases because they cannot access diagnostic services. Many are incorrectly diagnosed. As a result, they do not receive the treatment they need and, in some cases, may receive the wrong treatment.
To address this gap, WHO has published its first Essential Diagnostics List, a catalogue of 113 tests needed to diagnose the most common conditions as well as a number of priority diseases.
The Veterans Affairs Department inked a 10-year, $10 billion contract Thursday with Cerner Corp. to adopt the same commercial electronic health records system as the Pentagon.
Veterans Affairs Acting Secretary Robert Wilkie in a statement said VA’s future health records system will seamlessly communicate and exchange records with the Pentagon’s, resolving an issue that cost the agencies billions in recent years.
“President Trump has made very clear to me that he wants this contract to do right by both Veterans and taxpayers, and I can say now without a doubt that it does,” Wilkie said. “Signing this contract today is an enormous win for our nation’s veterans. It puts in place a modern IT system that will support the best possible health care for decades to come. That’s exactly what our nation’s heroes deserve.”
The contract with Cerner was announced last year by then-Veterans Affairs Secretary David Shulkin, but several issues, including congressional funding and Shulkin’s eventual firing, slowed the contract’s final signing.
According to Wilkie, the Cerner contract will allow the agencies to share patient data among Veterans Affairs, the Defense Department and community providers “through a secure system.” Combined, the two agencies have more than 20 million beneficiaries, including soldiers and veterans.
“Health information will be much easier to share, and health care will be much easier to coordinate and deliver, as well as faster and safer,” Wilkie said.
The department received nearly $800 million in funding from Congress for fiscal 2018 to begin the contract.
“We’re honored to have the opportunity to improve the health care experience for our nation’s veterans. The VA has a long history of pioneering health care technology innovation, and we look forward to helping deliver high-quality outcomes across the continuum of care,” said Cerner President Zane Burke, in a statement.
Meanwhile, the Defense Department is rolling out MHS Genesis, also developed by Cerner Corp., at four locations, but the pilot keeps hitting problems. That contract is worth up to $9 billion. Work temporarily stopped in February to address more than 14,000 help-desk tickets, many of which involved workflow changes. Pentagon testing and evaluation officials last week declared the system “neither operationally effective nor operationally suitable” after testing three of the four facilities.
Testing officials determined users could only about half the 197 tasks used as performance measures, and experienced latency issues and outages as more logged on. They concluded the end-to-end system couldn’t support the capacity of the four test sites even though the department expects to support 9.6 million beneficiaries from hundreds of facilities.
Defense officials said they will learn from the platform’s initial failures, and they’ll be working hand in hand with Veterans Affairs officials as the agency works to implement the same health records platform.
“VA and DoD are collaborating closely to ensure lessons learned at DoD sites will be implemented in future deployments at DoD as well as VA. We appreciate the DoD’s willingness to share its experiences implementing its electronic health record,” Wilkie said.
Article link: https://www.nextgov.com/it-modernization/2018/05/va-signs-10-billion-health-records-contract-cerner/148300/
The Pentagon is facing major setbacks in the rollout of its new electronic health records platform, and that dampens the outlook for the Veterans Affairs Department as it prepares to implement the same system, said the agency’s former leading technologist.
The Defense Department reported Friday the MHS Genesis system it’s spending $4.3 billion to develop “is neither operationally effective nor operationally suitable.” Initial field tests at three facilities were so bad the agency decided to cancel the testing at a fourth location and delay further pilots until it can address the numerous flaws it uncovered.
As the VA finalizes a contract potentially worth $16 billion with Cerner Corp. to put the agency’s 9 million beneficiaries on the same Genesis platform, former chief information officer Roger Baker told Nextgov the agency should prepare to face the same problems—if not more of them.
“It’s no surprise that a program as big as MHS Genesis…is going to have problems like this—according to all the metrics, most large federal IT programs aren’t successful,” said Baker, who held the department’s top tech job from 2009 to 2013. “[VA] need[s] to remember that the probability they’re flushing that $16 billion down the toilet is actually greater than 50 percent.”
But beyond the general challenges inherent in massive IT projects, VA faces an even steeper uphill battle implementing a new system than the Pentagon, Baker said.
For one, most VA doctors don’t mind the current platform. The VA’s electronic health system was rated the best for overall user satisfaction in a survey of more than 15,000 physicians, while the Pentagon’s current platform–the Armed Forces Health Longitudinal Technology Application–scored dead last. “What’s it going to look like when VA is trying to replace the most liked [platform] out there?” Baker said, especially when the military is having trouble convincing doctors to quit one of the least liked.
He also noted that unlike military physicians who are required to follow orders in a rigid command and control hierarchy, VA doctors can push back harder against system changes they don’t agree with.
“You can tell them what you want them to do, but they put patient care far above anything else, and they will tell you where to stick it if they think you’re impacting patient care,” he said.
That environment may not bode well for VA leaders looking to implement a system that during field tests reportedly experienced 156 incidents which could have led to patient deaths, according to Politico.
House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., has asked to meet with the agency’s leaders “in light of [the Pentagon report’s] troubling findings,” his communications director Tiffany Haverly told Nextgov.
Baker said VA might be even less equipped to lead a project of this size given the recent shakeups in agency leadership.
Staying focused on the final product and having “the wherewithal to say ‘no’” to anything that doesn’t serve that end is “the most critical” factor in the success of a large scale IT program, he said. And after former Secretary David Shulkin’s ouster, Baker doesn’t see anyone at the VA willing to take that stand.
“In making the decision to go to the new EHR, [Shulkin] demonstrated that he was willing to make very tough decisions whether people liked them or not,” Baker said. “Without that, the probability of success with any large IT program…is almost nil.”
He still finds it highly unlikely the Pentagon’s test results will unravel the Cerner deal, which VA Chief Financial Officer Jon Rychalski told Congress is scheduled to be signed May 28.
“I think VA’s too far down the road at this point,” Baker said.
To mitigate the chances the agency repeats the Pentagon’s failures, he suggested VA pilot Genesis at a single facility and work out the kinks before scaling to a larger rollout.
Article link: https://www.nextgov.com/cio-briefing/2018/05/pentagons-ehr-setbacks-dont-bode-well-potential-veterans-affairs-rollout/148200/
The test director recommends delaying further fieldings.The rollout of the Defense Department’s next-generation electronic health records system is not going smoothly.
Field tests of the Defense Department’s electronic health system at three locations went so poorly the testing agency scrapped plans to test at a fourth facility, according to a report released Friday.
Those three tests were enough to determine that “MHS GENESIS is neither operationally effective nor operationally suitable,” wrote Robert Behler, the department’s director of operational test and evaluation, in a letter dated April 30. In the letter, Behler recommended the department delay rolling the system out at other locations until his agency is able to complete its testing and the program manager fixes all the deficiencies they’ve found.
“While we still have challenges to come, we are clearly making significant progress. We continue to be and have been open and transparent,” Stacy Cummings, program executive officer for Defense Healthcare Management Systems told reporters Friday.
MHS Genesis is being developed by Cerner Corp. and systems integrator Leidos, which captured a $4.3 billion contract to build the next-generation health records system in 2015. Rollout of the system, which is eventually supposed to serve 9.6 million beneficiaries, was halted temporarily in February after it generated some 14,000 help tickets. Those issues are among several that have not been alleviated, according to Defense officials.
The initial test report found the system doesn’t demonstrate “enough workable functionality,” with users only able to perform 56 percent of the 197 tasks used as performance measures.
The list of flaws is long, including:
The latency issues and outages indicate the end-to-end system and supporting network couldn’t support the users at the four tests sites, let alone the hundreds of sites the department eventually plans to add, according to the report.
In a statement issued May 11, the Defense Department’s director of test and evaluation acknowledged the project’s complexity and said the PMO “has rapidly incorporated lessons learned from testing” and set up a board with representatives from the military services to improve usability.
“It’s important to get MHS Genesis right,” Defense Health Agency Director Vice Adm. Raquel Bono said. “All of the insight gained during initial deployment has helped us improve MHS Genesis at IOC sites and prepare ourselves for future deployment. I’m fully confident we will build on successes on IOC and address challenges identified.”
JITC plans to complete testing at the fourth site—Madigan Army Medical Center—after a Cerner Millennium upgrade, re-engineering and other systems improvements can be made. Madigan is the largest of the test sites.
In a call with reporters Friday, Cummings stopped short of saying issues highlighted in the report would delay the planned full deployment of MHS Genesis by 2022. Feedback from end users, such as clinicians and health care practitioners, “will be the main voice who is going to tell us if the configuration is ready to move to next site.”
“Users are the strongest voice for how we move forward,” Cummings said. “So the purpose of this time in the acquisition life cycle is make sure we have the solution in the right baseline and configuration we can take forward to the next sites,” Cummings said.
The issues with MHS Genesis come as the Veterans Affairs Department is determining whether to move forward on a contract with Cerner Corp. to build the same electronic health records system for its 10 million veteran beneficiaries. VA chose to adopt the same health records system as the Defense Department last year under then-Secretary David Shulkin, but his recent ouster and political infighting have left the contract up in the air.
It’s not just the VA looking to latch on to the program. In April, the Coast Guard announced it would adopt MHS Genesis after years of unsuccessful projects—and billions wasted—trying to build its own system.
| Policy | September 25, 2017
According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to diagnosis, prevent, treat, and hopefully improve both longevity and quality of life.
ysicians work with individual patients. We should strive to tailor care with our patient.
Productivity implies that we can count patient units. That idea really disrupts the essential “why” question?
If you are unfamiliar with “why,” I highly recommend Simon Sinek’s book Start With Why. Why did we become physicians? I think the answer for most physicians includes helping individual patients. We strive to do our best for each patient.
Where did productivity enter our profession? Most experts believe that Hsaio’s NEJM article, “Estimating Physicians’ Work for a Resource-Based Relative-Value Scale,” led to RVUs (relative value units) which many practice administrators use to measure “productivity.” Hsaio, a noted economist, wrote in the abstract of that article:
We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.
However, this model has led to gaming the system, and equating RVUs with hard work or productivity. But many physicians believe that the RVU system provides many wrong incentives, the most important being that shortening visit time leads to more patients per day and thus more money.
I wish physicians could just ignore RVUs and spend appropriate time with each patient. When physicians try to do this, practice administrators work to get physicians to see patients faster.
This leads to great stress for many physicians, and often unhappy patients. Many physicians believe that shorter visits (especially with primary care physicians) lead to more testing and consultations.
Productivity implies that seeing more patients each day is a good thing. But likely most patients and physicians will agree that we need to optimize the time with each patient. How many patients can we comfortably see in one day and deliver high-quality care? High-quality care does not refer to performance measures, but rather complex multi-dimensional factors that improve the patient experience. For many patients, talking is both therapeutic and diagnostic. We shorten our conversation time at the risk of diagnostic errors, higher health care costs, and dissatisfied, confused patients.
So please join the movement to ban productivity from medicine. We are not producing anything. We are caring for patients who need our full attention.
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
Article link: https://www.kevinmd.com/blog/2017/09/time-ban-productivity-medicine.html
On Monday, the U.S. Department of Health and Human Services (HHS) released its final rule for the 2019 plan year. This annual rule, called the Notice of Benefit and Payment Parameters, typically includes a broad range of changes that HHS intends to make for the next plan year for the Affordable Care Act’s (ACA) marketplaces and insurance market reforms. This is the first such rule of the Trump administration; the current 2018 plan year is governed by rules issued at the end of the Obama administration.
The rule makes a number of changes to the marketplaces that reflect President Trump’s Inauguration Day executive order that instructed federal agencies to relieve fiscal and regulatory burdens on states, individuals, and industry. HHS also notes the changes in the rule are intended to significantly expand the role of the states in the administration of the ACA, including providing states more flexibility in several areas such as benefits covered by plans, certification of plans, and the operation of “navigator” programs that help people enroll.
Although the stated goal is simplification, in at least one key way, the rule is likely to add more complexity to consumer’s health plan choices in 2019. At the same time, it leaves people with less help to sort through that complexity. Not only does the rule eliminate “simple choice” plans offered on the marketplaces, it reduces the number of navigators available to help people select plans.
Health insurers selling plans in the individual market are required to sell plans at four distinct levels that signal the amount of costs on average that are covered by a plan, or its actuarial value — bronze, silver, gold, and platinum. Along with the requirement that all plans in a given state must offer the same package of essential health benefits, this stratification greatly improved the ability of consumers to make apples-to-apples comparisons among plans. By contrast, on the pre-ACA individual market, it was often difficult for consumers to even know what a plan covered before they purchased it.
Still, competing insurance companies use a wide variety of combinations of deductibles, out-of-pocket limits, copayments and coinsurance, and deductible exclusions (services that the plan covers before the deductible is met) to arrive at the same average actuarial value for all enrollees in a plan. In a study of marketplace health plans, the Commonwealth Fund found that these different combinations can ultimately add up to very different costs for people enrolled in the plans, depending on how much and the types of health care services they end up needing in a given year.
Consumers understandably are often confused. While the federal marketplace website HealthCare.gov and state-run marketplaces feature a cost comparison tool that allows consumers to compare plans based on their potential out-of-pocket costs, having to compare a large number of plans can be overwhelming. Commonwealth Fund survey data have shown that many consumers continue to experience difficulty comparing plans on the basis of out-of-pocket costs.
In order to make choosing a plan less daunting, HHS created a set of “simple choice” plans for plan years 2017 and 2018. These are standardized health plans that insurers may elect to sell and which HHS differentially displays on HealthCare.gov to make them clear to consumers. The plans, which are offered at the bronze, silver, and gold level, have fixed deductibles, out-of-pocket limits, and copayments or coinsurance for health care services. In addition, they provide pre-deductible coverage for seven services and prescription drugs in most states and as many as 10 in states with state-specific cost-sharing limits.
The rationale behind the plans was twofold. The first was to simplify the shopping experience for consumers. Comparing two plans offered by two different insurance companies is far simpler if the cost-sharing is the same. Consumers can focus on differences between the plans on premium and the providers included in the network, for example. Second, the standardized plans also include beneficial features (such as pre-deductible services) that might not otherwise be available in some markets. A broader goal of standardizing is to encourage insurers to compete for enrollees on the basis of the value of the health care provided by their plans.
In its rule, HHS claims that dropping simple choice plans is consistent with promoting free market principles in the individual market and that the standardized plans stifle innovation. But insurers always had the option to decide whether to offer the plans, and could therefore offer plans with innovative designs.
HHS’s decision not to feature simple choice plans in 2019 may be confusing to consumers who had enrolled in the plans in the past two years. In addition, the rule eliminates the requirement that insurers offer plans that are meaningfully different from one other, which will likely lead to more plans and choices in some markets. Moreover, consumers in some states may have fewer people to help them sort through their plan choices. In the rule, HHS reduces the number of navigators states are required to make available to consumers from two to one. In addition, the rule no longer requires that navigators maintain a physical presence in the state in order to provide face-to-face assistance to consumers. These changes come on the heels of a deep cut in federal funding for advertising and the navigator program during last year’s open enrollment period.
Several state-based marketplaces offer standardized health plans and won’t be affected by the new rule. California’s marketplace, Covered California, in particular has been a leader in simplifying plan options for consumers and driving its individual market toward higher-value health plans. It only allows the sale of plans that meet standardized designs set by the marketplace, which it refers to as patient-centered benefit designs.
Simple choice plans were an innovative attempt to improve the ability of consumers to make decisions about health plans that have consequences for their ability to maintain their health. While HHS has retreated from its experiment with standard plans, states that run their own marketplaces can continue to innovate.
Article link: http://www.commonwealthfund.org/publications/blog/2018/apr/the-trump-administrations-new-marketplace-rules
