A West Palm Beach doctor’s ties to Donald Trump’s Mar-a-Lago social circle have enabled him to hold up the biggest health information technology project in history — the transformation of the VA’s digital records system.
Dr. Bruce Moskowitz, an internist and friend of Trump confidant Ike Perlmutter, who advises the president informally on vet issues, objected to the $16 billion Department of Veterans Affairs project because he doesn’t like the Cerner Corp. software he uses at two Florida hospitals, according to four former and current senior VA officials. Cerner technology is a cornerstone of the VA project.
With the White House’s approval, Moskowitz has been on two or three monthly calls since November with the contracting team responsible for implementing the 10-year project, according to two former senior VA officials. Perlmutter, the Marvel Entertainment chairman, has also been on some of the calls, they said.
Many doctors and health IT experts are skeptical of the VA deal — especially after the problem-ridden implementation of a similar system at military hospitals. However, the involvement of Moskowitz and Perlmutter, which has not previously been reported, infuriated clinicians involved in the VA project, including former Secretary David Shulkin, according to one of the sources, a former senior VA official. Several officials said they thought contract negotiations had been wrapped up earlier this year and had no idea why the project was being held up.
“Shulkin would say, “Who the hell is this person who practices medicine in Florida and has never run a health care system?” said the source. He said Moskowitz’s involvement was one of the irritants in Shulkin’s dealings with other White House-appointed officials, which contributed to his being fired March 28.
The behind-the-scenes talks, where Moskowitz questioned various aspects of the program, illustrate the degree to which members of Trump’s circle have been able to influence government decisions, even about extraordinarily specialized subjects.
That involvement has stupified policymakers, especially since members of Trump’s family had pushed the opposite agenda: Trump’s son-in-law, Jared Kushner, was instrumental in Shulkin’s June 2017 decision to choose the Cerner Corp. system with a no-bid contract. Shulkin announced the Cerner deal after several White House meetings with Kushner and aides from his Office of American Innovation.
But Moskowitz’s concerns effectively delayed the agreement for months, the sources said. VA spokesman Curt Cashour said Wednesday that finalizing a decision on the modernization of the VA’s health record system was a priority for acting Secretary Robert Wilkie.
Cashour didn’t respond specifically to questions about Moskowitz’s role. “Proper due diligence is required to ensure the best interests of veterans and taxpayers are served before the department enters into any agreement of this size and importance,” he said. “We are doing that now, and expect to make a final decision and corresponding announcement … in the coming weeks.”
Shulkin declined to comment for this story, as did Cerner Corp. Moskowitz and the White House did not respond to requests for comment.
Moskowitz, trained in medicine at the University of Miami, is a beloved West Palm Beach physician who sits on medical nonprofit boards with billionaires. He has invested in projects like an iPhone app to help patients find emergency care and a registry to track medical-device safety issues. Moskowitz also has “a great Rolodex,” in the words of one VA official, with many contacts at top-rank facilities such as the Mayo Clinic — where he sends his patients for specialty care.
In December 2016, he and Perlmutter helped broker a Mar-a-Lago meeting between Trump and leading health care executives from Mayo, the Johns Hopkins University Hospital, the Cleveland Clinic and other big systems.
Perlmutter, meanwhile, has been advising Trump on veterans affairs since before the inauguration. Some news reports say the Israeli-born businessman’s interest in veterans stems from serving in the Six-Day War of 1967.
While Moskowitz’s complaints about the software he’s used in Florida are not unusual, IT specialists at the VA felt that he was out of his league in evaluating the Cerner deal. After listening to his complaints, a team of investigators from VA’s Office of Information and Technology looked into the Cerner system that Moskowitz uses at two Tenet Corp. hospitals in Florida and found that it was out of date, two sources said.
Yet Moskowitz assumed that if his hospitals lacked a feature, it meant that Cerner could not produce it for the VA, they said.
‘”He’d be, like, ‘It doesn’t’ have voice-recognition software.’ Yes, Cerner does have voice-recognition software. But it isn’t installed in all Cerner hospitals.”
“This was part of the rub between Shulkin and the Trump people,” the first source said. “This guy’s whispering in Trump’s ear, ‘I know because I have to use it!’”
Shulkin’s June 2017 decision to jettison its homegrown digital records systems was controversial from the start. Many VA physicians rate the VA system highly, but Shulkin decided it would be best to use the same Cerner software system the military had chosen in 2015 so that records could be more easily shared.
The military has experienced numerous glitches since implementing the Cerner software at four Washington state clinics and hospitals last year, however. At a hearing Thursday, Democratic Sen. Patty Murray said these problems have had a “significant morale impact on the practitioners in my state, not to mention serious concerns about putting patients’ lives at risk.”
Stacy Cummings, who runs the project for the military, testified that despite the challenges, the implementation is on track to finish nationwide in 2022. The VA is moving forward with its plan to use the same Cerner system “as far as I know,” she added.
Many health care and technology leaders view the combined VA-DoD Cerner project as a crucible for the future of computerized health care in the United States. Kushner hosted at least four White House meetings from December through February at which the project was central to discussions.
VA officials were aware of the potential pitfalls. Last fall, Shulkin postponed signing the final agreement while seeking assurance that the Cerner software could enable health data exchange with private-sector doctors who see veterans. But the contract appeared to be back on track in January after delivery of an independent report Shulkin commissioned to review the issue.
“I thought it was going to be done in a few days after that,’’ said a congressional source who tracks the deal. “Now it looks like there isn’t any tangible path forward.”
In a related move, an individual with ties to Trump-appointed VA officials said last week that an inspector-general’s report had been opened into the Cerner sole-source purchase.
Several IT experts consulted on this story said they thought the Cerner deal eventually would go through. Most said it would not be realistic to expect officials to renegotiate the contract or ditch it to stay with the VA’s internal software system.
“We just had to make the Mar-a-Lago guys comfortable with the deal,” said a current VA official. “They have someone’s ear. Power and influence are power and influence.”