The problems facing VA modernization are bigger than its software systems
The list of criticisms of the new Veterans Affairs (VA) electronic health record system, Oracle Cerner, is long.
Thousands of doctors’ orders went missing, putting patient safety at risk. Its downtime has been high compared to the old system, though it has improved. The new system is expensive: $16 billion so far, up from the $10 billion originally estimated. And, so far, it has been rolled out at just five of the VA’s 171 sites.
One of the problems is that the old record system, VistA, has its own lengthy list of reasons why it cannot continue to serve as the main software for VA hospitals. VistA was coded in Mumps, a computer language so old that few programmers are available to work on it. This old system is also not cloud-based, and cloud-based systems are now standard. And each VA location has customized VistA for its own particular needs, which means that each system is, in its way, unique, and interoperability is not-at-all simple.
Even those who still love VistA concede that sticking with the old software is not a long-term solution. And even in the short-term, VistA is expensive to maintain, costing $900 million for this purpose just last year. So VA has been sinking money into two different electronic health record systems, each one broken in its own way.
As of last Friday, VA has called for a complete reset of the modernization program and a halt to any further Oracle Cerner rollouts.
How did this implementation go so wrong? And what should be done now?
Electronic health record (EHR) implementations often take a long time and go over budget. And while the VA implementation of its new EHR software has been challenging for a number of reasons, all of these reasons could be, and indeed were, anticipated.
VA is unique in its geographical breadth — most EHR rollouts occur in a single health care system that is physically situated in one state, not across 50. Most EHRs, including the new Oracle Cerner system, are designed around billing, which is not a focus for providers in VA hospitals. The VA patient population is also different than the general public, with different frequencies of disease (more PTSD and missing limbs; less pregnancy and pediatric care), and it requires management of referrals and care outside the VA system.
Meet the cheapest US states to buy a house
A new study analyzing Zillow data has found that the monthly median sale price of a house last year was more than $500,000 in Utah, California and Colorado — and more than a staggering $800,000 in Hawaii.
The study, conducted by Studio City realtors, found that Hawaii clocked in as the most expensive state in the U.S. for homebuyers. On the island, the average home price was $805,775 — hundreds of thousands of dollars more than the cheapest state on the list.
Studio City realtor Tony Mariotti noted that market turbulence contributed to a “significant increase” in house prices across the U.S.
Home prices went up nationwide in February after months of declines amid low inventory and a small uptick in demand — and experts have said they expect affordability will continue to be a problem for prospective homebuyers in the months ahead.
Here are the priciest and cheapest U.S. states to buy a home:
The most expensive states to buy a home
Eight states and Washington, D.C., saw a monthly median sale price of a house last year of $400,000 or higher, with Oregon sitting at that exact figure.
Washington state, Nevada, Montana and Washington, D.C., came in between $402,900 and $487,500.
California, Colorado and Hawaii were the top three most expensive, at $537,000, $537,125 and $805,775 in monthly median sale prices last year, respectively.
Costs differed in different areas within states: for example, the median monthly sale price of a house last year in California’s cheapest city of Red Bluff was $320,000 — while the ticket in its most expensive city of San Jose was $1,370,000.
Don’t just hug a tree this Arbor Day — plant one, too
Nearly five years ago, Hurricane Michael became the first Category 5 storm to hit the United States in 25 years. It left a trail of destruction in its wake, and my community of Panama City — located in the Florida Panhandle — was hit especially hard. Since then, working together as neighbors and citizens, we’ve made significant progress in key recovery areas, including rebuilding key and vital infrastructure, enhancing quality of life, developing our downtown, and attracting new businesses across a mix of industries. However, one of our most important recovery efforts lies within our tree canopy restoration — an often overlooked but vital area of disaster recovery and prevention.
When Hurricane Michael uprooted nearly 80 percent of Panama City’s trees — approximately a million trees, generating 5.7 million cubic yards of debris within the city — it created serious challenges. Not only did we lose the beautiful canopy from 100-year-old oak trees, but the vital function of the trees was lost, the first of which was the absorption of groundwater. The loss of so many trees significantly increased the risk of flooding in our community,
where we now experience flooding in areas that haven’t typically flooded in the 114-year history of the city. The second function lost from the lack of trees is shade.
Trees serve to mitigate the urban heat island effect, where an entire city is warmed by concrete being heated by the sun. These increased temperatures not only result in uncomfortably hot weather but can also lead to other extreme weather events like wildfires. Since the storm, Panama City has experienced increased flooding whenever thunderstorms roll through, in addition to wildfires that consumed over 40,000 acres last year – both due in part to the damaged tree canopy and loss of trees.
In Daring Op, Air Force Pilots Use Night Vision Goggles To Land In Sudan
The Indian Air Force landed its C-130J Hercules transport aircraft on an airstrip, which was in a degraded condition with no navigational approach aids or fuel.
The C-130J landed on an airstrip in Wadi Sayyidna in Sudan to rescue Indians
The Indian Air Force conducted a daring night operation by flying into an unprepared runway in the darkness to rescue 121 personnel from a small airstrip in violence-hit Sudan Thursday night.
The Indian Air Force landed its C-130J Hercules transport aircraft on an airstrip, which was in a degraded condition with no navigational approach aids or fuel and landing lights that are needed to guide an aircraft to land at night.
The C-130J landed on an airstrip in Wadi Sayyidna in Sudan to rescue passengers who had no means to reach the Port Of Sudan.
The Air Force pilots used Night Vision Goggles (NVGs) to carry out a flawless landing at night. While approaching the airstrip, the aircrew used their Electro-Optical/Infra-Red sensors to ensure there is no obstruction on the small runway, which is about 40 Km north of Khartoum, the said epicenter of violence in Sudan.
After ensuring the runway is clear, the daring pilots carried out a tactical approach. Upon landing, the aircraft engines were kept running.
Eight Garuda commandos from Air Force’s special forces unit secured the passengers and ensured the safe boarding of luggage in the aircraft.
Similar to the flawless landing on the blind airstrip, the take-off was also carried out using NVGs.
The two and an hour operation between Wadi Sayyidna and Jeddah is similar to the one carried out in Kabul and is another testament to the air force’s sheer audacity to conduct daring operations during a humanitarian crisis.
Today, India brought 754 home under ‘Operation Kaveri’ to evacute stranded Indians in Sudan. While 392 people were flown to Delhi in the C-17 transport aircraft by the air force, the remaining 362 Indians were brought to Bengaluru.
A total of 1,360 Indian have been brought back to India since the rescue operation began.
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The fighting in Sudan is part of the ongoing clashes between the country’s army and the paramilitary Rapid Support Forces (RSF).
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