Apple + VA? The very idea sounds cuckoo

Why does the Department of Veterans Affairs need Apple for mobile electronic health record, and why should Apple get a prescription cut?

Some stories get re-reported so many times they grow legs. A case in point: A gambit by Apple to develop technology for veterans to store their Department of Veterans Affairs health records on their iPhones.


I counted at least a dozen big and small news sites that referenced this slightly cryptic Wall Street Journal story. When I saw the original headline, I thought, “well I’ll be darned.”

The story describes an email debate between Darin Selznick and one Dr. Bruce Moskowitz. The former was a VA “adviser” and Trump transition team member who left the agency when President Donald Trump fired Secretary David Shulkin. The latter is associated with the president’s Mar-A-Lago clan that various published reports over the past couple of years have described as a sort of shadow veterans administration pushing for adoption of a commercial electronic health record system.

The upshot, according to the story, is some sort of developmental collaboration between Apple and VA.

I’m not questioning the Wall Street Journal story itself. Although it does cite several, unnamed people “familiar with” the situation. Those people say the app resulting from this collaboration would enable automatic prescription refills. Apple would collect a royalty of 15 percent on each of the millions and millions of refills each year.

My question is why on earth would anyone at VA even give two seconds thought to such an arrangement? What health care provider, in this day and age, would cut in another party to cream 15 percent off prescription revenues? Nearly every major health care provider already has an arrangement with a prescription outfit that enables automatic refills.

Indeed, VA itself already does.

If you go to the newly redone VA web site, in one click, you find this statement: “With our VA Prescription Refill and Tracking tool, you can refill your VA prescriptions, track their delivery, and create lists to organize your medicines. Find out if you’re eligible and how to sign up to begin using this tool in our health management portal within My HealtheVet.” If this functionality exists, what does VA need with Apple?

From an EHR standpoint, the collaboration makes no sense either. Somewhere along the line VA decided to scrap its 50-year investment in VistA. Shulkin fatefully, and probably not legally, chose a new EHR provider by fiat. Now both VA and the Defense Department are struggling in their entanglements with Cerner Corporation, to which they’ve both pledged billions and billions of dollars for a supposedly interoperable record. And after all that, VA would have a single proprietary app monopolize the mobile version of this uber-record?

Again, it makes no sense. Moreover, the VA’s “blue button” technology has been there for years, letting veterans access their own records. VA’s mobile blue button app is available for iOS, Android and Windows devices, although it is not as fully functional as the desktop blue button. But considering what it does do, it doesn’t seem like a big leap for VA to boost the app’s capabilities.

From an acquisition standpoint, a collaboration with Apple ought to raise questions. After all, Apple is not the only one with the capability of writing apps to iOS instructions. With about a million developers out there who also develop apps, I wonder if VA ran a competition?

Any way you look at it, this purported arrangement — and of course, Apple had nothing to say about it — raises more questions than answers.

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