An Open Letter: Parker Health responds to Oracle’s VA Electronic Health Record Modernization Debacle.

  • By Vince Lopez, Founder & CEO, Parker Health

    Feb 27, 2023

There is an old saying, people are a product of their environment. Parker Health as an entity is no different. A few years ago, when I started Parker Health, Inc. a health technology firm, with one goal, to change healthcare. I asked Chris Parker to come aboard, I gave him one challenge before accepting the role of chief technology officer. The challenge was simple, visit his primary care physician and ask them how they feel about their electronic health record system.

He was not expecting the answer he received. Upon asking a few nurses at Dr. Fram’s office, and then Dr. Fram himself how they felt about their EHR; similar phrases “I hate it”, “very outdated”, and a few more sounded like a choir. I knew what he would hear, but he needed to experience it. Chris’s mother has been a nurse since he was four years old. She would go on to work at the very hospital she gave birth to him. She is a veteran (US Army) and her last job before retirement was at the Veteran’s Affairs hospital. His mom has worked with just about every EHR on the market up to 2018, and she repeated that same words his primary care office shared. We have several friends that are nurses and doctors and not one had anything good to say about the legacy EHR’s companies.

The legacy electronic health record manufacturers Cerner, Epic, Allscripts, sell software packages north of one hundred million dollars (USD) routinely and everyone we’ve met with or asked that’s used them, has not had a single good thing to say.

The United States of America’s healthcare system is one of the most advanced and well-equipped in the world. However, despite its many strengths, there are several challenges that the healthcare system faces, especially regarding electronic health records (EHRs). The implementation of EHRs was supposed to make healthcare more efficient and cost-effective. Unfortunately, this has not been the case. The high cost of EHRs is one of the significant issues faced by the US healthcare system. And the conversation around data sovereignty, patient access, and general interoperability has been such a significant challenge, because no one wants to work together. It’s all about the money.

In 2009, the American Recovery and Reinvestment Act (ARRA) was signed into law, providing incentives to healthcare providers to adopt EHRs. Since then, the number of healthcare providers who have adopted EHRs has increased dramatically. According to the Office of the National Coordinator for Health Information Technology (ONC), over 90% of hospitals in the US have adopted EHRs, and over 80% of office-based physicians have also done the same. However, despite the widespread adoption of EHRs, the cost of these systems has remained high. Independently owned primary care facilities and other specialty offices that need EHRs can’t afford them; and if they have an EHR they’re more than likely owned by a major hospital or venture group, but they usually only have access to an extremely stripped-down or outdated module of i.e., Epic, Cerner, or Allscripts.

Since 2009, the cost of EHRs has become more expensive, and the implemented technology hasn’t improved with modern technology standards. In starting this position, Chris was new to the industry, however, just like everyone else, he knew that healthcare costs were out of control. The EHR plays a vital role in mitigating cost, streamlining care, and enhancing a positive patient experience. Paying hundreds of millions of dollars for an antiquated system is a large cost that is passed on to patients’ day in and day out.

One of the main reasons for the high cost of EHRs is the lack of competition in the market. A small number of companies dominate the EHR market, and as a result, prices remain high. Just like any disruptive startup, we knew we could create an advanced, interoperable, compliant EHR that works, is easy to train and use, and is cloud-based. We want our product to be affordable for small practices, rural hospitals, and urban hospital systems. We built a solution that could monitor all aspects of the health system and circumvent the process and needs for third-party middlemen. Eliminating the needs for Group Purchasing Organizations (GPOs), Pharmaceutical Benefit Managers (PBMs), and other middlemen who drive up cost, and provide zero value add to the quality of care and patient outcomes. The entire PBM and GPO model is a scam.

In our research, we were shocked to find that many small practices still use paper or are reduced to using homebrewed solutions that often include Microsoft Access. The large EHR manufacturers have helped to create such a large digital divide. Our team also found that many large hospital systems only use their expensive implementation on the hospital level as it is too expensive to include them in their smaller subsidiary facilities and clinics. The price per bed and per system user (practitioner, staff, etc.), make it cost-prohibited to attain interoperability even within their own healthcare organizational structure. Furthering the digital divide, creating additional data silos, and frustrating patients. Our patients and practitioners deserve better.

In the spring of 2021, Parker Health challenged the Cerner’s VA EHR Modernization Contract (Contract #: 36C10B18D5000) deal by sending a two-white paper to congress. We took many meetings on the hill discussing our concerns regarding this large sole-sourced contract. We also spent time educating our lawmakers on the challenges in the clinical setting, data security and compliancy standards.

Two of Parker Health’s senior executives, Kenneth (Army) and Miko (Airforce) are fully disabled veterans, who have served our Nation honorably, but now have been treated with total disregard by the VA. During our meetings in Washington, we meet with top leadership at the US. Department of Veteran Affairs, including Dr. Terry Adirim who until her recent termination was the head of the VA EHR implementation project. Our team raised our concerns regarding the VA contract, security and compliancy, the many failures, and Kenneth and Miko shared their experience as VA recipients. Listening to their horror stories with the VA will discourage even the toughest of us, but not Dr. Adirim. She proceeded to laugh in our face and was adamant that there was nothing wrong with the EHR program. She even went as far to tell Kenneth and Miko, “perhaps you should seek care elsewhere, besides the VA.” She’s a medical doctor, she previously led the Cerner program for DoD at DHA, and now working for the VA directly, but insulting our veterans was disgusting to watch, totally unprofessional, and inappropriate at every level. Her termination comes as no surprise, but it should’ve come sooner.

The introduction of H.R. 608 to cancel the modernization act, was not a surprise to us. Many on the hill expressed their rage at the increasing cost and lack of implementation. If you are new to the issues of Cerner Millennium EHR and the VA rollout, let me explain, and give you quick facts about the VA.

The Department of Veterans Affairs (VA) is ranked fifth in spending among all federal agencies and accounts for 5% of all federal spending. Expenditures have nearly tripled in the past 20 years, from $70 billion in the fiscal year 2000 to $200 billion in 2019. However, simultaneously, the veteran population in the US has shrunk and increased in age, thereby increasing healthcare costs. The number of veterans declined by one-third, from 26 million to 19 million, from 2000 to 2019. According to the US Census Bureau, veterans went from 9% of the population in 2000 to 5% in 2019.

Although the number of veterans is declining, VA’s medical care spending has risen much faster than inflation. The Veteran Population to VA Medical Spending chart below reveals the extent of the VA’s problem. In the past ten years, VA medical spending has risen from $43 billion in 2011 to $88 billion in 2021, while the number of veterans fell from 22 million in 2011 to just over 19 million in 2021. This is a clear sign of increased healthcare costs for veterans.

With the projections for VA medical spending to be north of $105 billion by 2028, the VA has demonstrated significant concern about the problem. According to the VA, a major factor in the rising costs of health care is the increasing age of the veterans and the implementation of the MISSION Act Strategies to combat the soaring cost include changes in the copay structure, public-private healthcare partnerships, limiting access to out-of-network doctors, telehealth, mobile clinics, and wearable technologies are all being considered.

On May 17, 2018, the VA announced that it would be transitioning from its current EHR system to the Cerner Millennium EHR, also used by the Department of Defense. The VA’s goal was to create a single, integrated EHR system for all veterans, regardless of where they received their care. However, the implementation of the Cerner system has been plagued by problems and delays.

One of the most notable failures was the implementation of the Cerner EHR system was the fact that it would cost over $16B for a 10-year rollout. After more than three years into a $16 billion contract (over $5B paid out), Cerner has not produced a basic EHR product that meets the requirements, functionalities, and deliverables specific to this award. Further, what has been delivered has significant errors and is inoperable. The high cost of the project has been a source of concern for many, and there are questions about whether the VA will be able to fully fund the implementation of the system.

An additional issue with the Cerner Millennium EHR implementation has been the lack of interoperability between the VA and the Department of Defense. Despite both organizations using the same EHR system, the systems are not fully integrated, which has resulted in delays and inefficiencies in the delivery of care to veterans. This has been a major source of frustration for veterans and healthcare providers alike.

You may notice I say Cerner and not Oracle, as we can’t blame Oracle for this debacle. I am sure the Cerner VA EHR deal was a part of the $28B price tag. Oracle bought a company with little competition and an even smaller desire to innovate. Former Cerner executives left Oracle to not take responsibility for the mess they have created. It is impossible to think they did not know, at the time of the sale, the issues they had in implementing and scaling which have been on the front cover of national news since 2021 at the very earliest. This sale might comeback to bite Oracle shareholders, but this sale clearly demonstrates the greed and over capitalization of the healthcare industry.

On February 3rd 2023, Oracles’ Ken Glueck, Executive Vice President published an open letter response to H.R. 608 titled “Veterans Deserve Better than VistA.” Talk about a moment of solace, arrogance, and narcissism.

In their response they think it is a bad idea to go back to VistA, however the VA has been operating on VistA for the pass years due to the failures of the Cerner Millennium EHR deployment, so what is the VA missing? Oracle is not going down without a fight, they have billions of dollars on the line, and shareholders to please, is this much more important than veterans? However, if a majority of the VA is still on VistA, then I argue canceling this terrible deal changes nothing for most of the VA. Over 80% of the VA will be unaffected by the passing of this bill. Oracle’s rebuttal is mostly self-serving.

Bottom line our veterans deserve better than Oracle Cerner and Epic. It’s time for that new kid on the block, Parker Health, to lead the way! Our Veterans fight for our freedoms daily, then come home and are forced to deal with the inept processes of the VA. For example, the simple task of scheduling appointments, seeking medical services, receiving lab results, requesting a prescription refill, etc. As a tax-paying American, it is a direct slap in the face that our country has spent over $5B dollars on a product that doesn’t work, isn’t cloud-based, and uses 2005 technology in 2023. We should not stand for our veterans having to deal with such disrespect of their service and that Oracle-Cerner simply equates it to being patience; while we spend two years fixing code that shouldn’t even be in existence, on a cloud provider, that according to Yahoo finance ranks 8th in customer usage, a meager 2% of the total market share.

We support Rep. Matt Rosendale(R-Mont) and his legislation H.R. 608 it’s time that our leaders stand up and fight for our veterans, because they deserve better. We support this fight and will continue to fight this sole-source debacle. We will fight for all Americans which deserve better healthcare and not to have their costs raised because a hospital system can only pick from over-priced and outdated technology providers.

Join us in supporting H.R. 608 and let’s get this debacle past us and help our VA implement a cost-effective product the Parker Suite, that takes minutes to onboard, minutes to learn, and works on form factors practitioners like to carry in their pockets, not a laptop strapped to a cart we all have seen wheeled into our visits.

“Make no mistake, modernization of the electronic health record is not optional — one way or another, it has to be done,” Sen. Jon Tester (D-Mont) said in an emailed statement to Nextgov. Parker Health is here to help! We’re confident that we can deliver. We can deliver a working product, on-time, and under budget.

We have submitted yet again another white paper voicing our concerns to the VA Subcommittee on Technology Modernization. Parker Health has a requested a meeting Rep. Matt Rosendale, and with President Biden, at the White House to further the dialogue. We’re confident that concerns we raise will always be only factual and are detrimental to the national security of our Nation.

Again, I urge my fellow Americans to call your representatives in Congress today, because our veterans deserve better.

Both white-papers can be viewed below.

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