• Kris Neilson, 59, decided to go back to school and pursue her MBA in her 50s.
• While she had a bachelor's degree, she wasn't advancing in her career or increasing her earnings.
• Although she had to take out student loans, she believes education later in life can pay off. 

Despite earning her bachelor's degree decades ago, Kris Neilson's career has remained stagnant.

Neilson, 59, went into retail management after earning a general studies degree with a business concentration. While she moved on to other sales jobs and eventually landed her current role at a nonprofit, her wages weren't increasing that much, and she wasn't passionate about the work she was doing.

On top of that, she recognized herself as the second-income earner in her marriage — she was earning money to contribute to the household, which she said fit her and her family's situation at the time.

But things have changed. Neilson and her then-husband divorced nine years ago, leaving her without a chunk of the income she was used to having to support herself. Her income at the time was enough to cover her basic expenses, but she didn't have any extra money to put toward retirement, so she started sending out dozens of job applications, to no avail.

"Ageism was, and is, extremely prevalent," Neilson told Business Insider. "And because I didn't have a strong skill set, or at least a marketable one, I was barely getting by. I was using family members to help me cover my expenses."

Neilson took that as a sign that it was time for her to return to school and give herself another chance to advance in her career and further her education. At 57, she enrolled in an online program part time to pursue an MBA, and she graduated this May.

She now has just over $42,000 in student loans, according to documents reviewed by BI — meaning that instead of saving more for retirement, she has to focus on paying off her debt. But she thinks it'll be worth it.

"I believe in lifelong learning, and I just don't want to be irrelevant," Neilson said. "I don't want my skills to fall back again."

It can be difficult for older adults to return to school due to the demands of the workforce, but with a degree still providing value in terms of career advancement and higher wages, it's a path some adults might choose to take. According to a recent National Bureau of Economic Research paper, about 20% of college graduates born in 1930 and later got their degrees after age 30.

Additionally, per the paper, 70% of the increase in overall college completion from 1990 to 2010 can be attributed to the increasing number of adults getting their degrees after their mid-twenties. It found that while younger graduates have the greatest wage benefits they can enjoy for longer, "late graduates also receive a substantial college premium after graduation," suggesting they can also receive wage benefits.

It's too early for Neilson to know if her degree will pay off, but she said she didn't think it was too late to give herself a chance.

"This definitely boosted my confidence, but it certainly doesn't just feel like I'm set," she said. "It keeps me hungry for more. I feel like I need to continue to pursue further education, just so I do have something that people want."

'It's scary as hell'

The uncertainty about where Neilson will go now that she has her MBA is unnerving. She'll soon have to begin paying off her student loans, which means she'll have even less money to save — and she said she doesn't see herself retiring until she's 75, at the earliest.

"I have my MBA, but I'm still a 59-year-old woman, single, and I not only need to keep my skills sharp, but I need to keep my health sharp, so it's scary as hell," Neilson said. "The money that I would like to be able to contribute to a retirement account is going to go instead to pay student loans."

BI has previously spoken to some other older adults who have struggled with career progression later in life. For example, Crystal, a 62-year-old, never received a college degree, and it's kept her from progressing in the workforce. She said she sees herself working part-time well into retirement because she cannot afford to go without a paycheck.

"With my age, I was just not attractive on paper, and not having a college degree was always a factor, too," Crystal said. "I could send out 200 applications and résumés and maybe get two calls and then not even be invited in for an interview."

It shows how, even as more Gen Zers do not see the value of higher education, a degree is still coveted — a recent report from Gallup and the Lumina Foundation found that adults' interest in higher education is "as at the highest level" the organizations have recorded.

Of course, it's not something everyone can afford. Still, Neilson said she felt she owed it to herself to take on student loans and continue her education, and she thinks it's an option that should be more readily available to older adults.

"I don't want to live life and regret it, but I really shake my head when I think about a path that I wish I would have known about, known better or known different when I was younger and had had the foresight," Neilson said. "But I'm really glad I did what I did, even though it's scary to know what the future holds."

Did you return to school later in life? What impact has it had on you? Share your story with this reporter at asheffey@businessinsider.com.

Instagram would super-duper like everyone to post more, especially creators. In a landscape where people are posting less and less on social media overall, making the platform seem active and vibrant is crucial to keeping people's attention. So Instagram is pulling out all the stops, or at least some stops, to get users to share, some of which may be more worthwhile than others.

I've recently noticed that the company has been giving people with creator and business accounts virtual rewards for certain "achievements" or milestones on the platform. If a user adds to their stories at least seven days in a row or gets a certain number of plays of their reels, they receive a badge that amounts to a digital "woo-hoo." While the feature has been around since late last year, Instagram promoted it in a blog post early this month. It also included some tips on making the most of the feature and succeeding on the platform, including tracking "achievement" progress, posting regularly, and encouraging followers to interact — the thing that makes the whole social-media machine work.

Plenty of apps are gamified to try to get people to engage and stick around, even if the rewards they get for playing along are meaningless. Fitness apps congratulate you for working out X number of days in a row or getting your steps in. Wordle lets you track your streaks, as does the language-learning app Duolingo. Gamification can be fun — it feels kind of neat to get a little congrats for getting your steps in. But it can also be icky. It can distort behavior, putting focus on getting whatever achievement instead of accomplishing the task at hand. It may even make people who don't hit certain goals feel like they're lesser, especially if their shortcomings are visible to others. (Instagram's new badges are private unless creators choose to share them.)

The badges aren't a stick, but they're not exactly a carrot, either — well, maybe one of those soggy baby carrots at the bottom of the bag in the back of your fridge.

From a business perspective, Instagram's move makes some sense. Instagram is a key part of Meta's overall business and a major revenue generator. Court filings that came out earlier this year revealed that Instagram generated $32.4 billion in ad revenue in 2021, 27% of Meta's total revenue and more ad revenue than YouTube brought in. In a business landscape where Meta has been dumping tons of money into the metaverse and artificial intelligence, Instagram's continued success is vital.

"You could talk to a lot of people and they would suggest that essentially most or all the company's growth more recently has come from Instagram. And so they're obviously trying to think of ways not only to keep people engaged, but I think they're very cognizant of pretty constant competitive threats," Scott Kessler, the global sector lead of technology, media, and telecommunications at Third Bridge Group, said. That includes direct rivals such as TikTok and Snapchat, as well as all the other things on and off the internet that are contending for people's attention at all times.

In particular, Instagram needs to keep Gen Z and people even younger coming back to the platform, even if it's not always great for their mental health and well-being. Doing that requires a constant flow of new content so the platform doesn't become just a sea of ads and irrelevant, boring stuff. Instagram's parent company, Meta, doesn't want it to go the way of Facebook, which for many people, serves as a tool for birthday reminders and seeing what their one weird aunt is up to, if they ever sign in at all.

While it is understandable why Instagram would do this, whether it will work is another question. People are already posting for likes, attention, and clout. Adding a little badge to show one's personal achievements makes the endeavor feel more official, but it's not clear how much it will make a difference.

I don't see badges being the solution to increase posting cadence.

Ali Grant, a partner and the chief marketing officer at the Digital Dept., an influencer-management company, told me she understood the idea of trying the gamification concept — she sees it all the time in corporate. She has her doubts about how effective this will be, though.

"What creators want on the platform is reach and engagement," she told me. "When that's lacking, the motivation to post dwindles, and they seek it elsewhere. I don't see badges being the solution to increase posting cadence."

The number of posts being added by content creators, or really anyone for that matter, seems to be at an all-time low, Grant said. The creators who post consistently are the ones who see more growth and engagement, but regularity still doesn't guarantee success, and there's no clear rhyme or reason to what ends up getting the most attention.

"There's this pressure to create aesthetically elevated content for Instagram, and that deters people from posting as much as they might on stories or on TikTok, which is less curated and more of the moment," Grant said. "It's a mix of bandwidth issues and pressure for the type of content required for in-feed Instagram posts."

Alixandra Barasch, a marketing professor at the University of Colorado Boulder's Leeds School of Business who studies how new technologies influence consumer behavior, was also dubious of this whole Instagram badge situation. People like setting and achieving goals, including keeping a streak, which becomes a goal in and of itself. But an Instagram posting streak is different from, say, exercising every week for a year or doing a language lesson daily, both of which have intrinsic value. There's enjoyment and satisfaction in the action itself beyond the extrinsic reward. You feel good about trying to get in shape or practicing Spanish no matter who sees; that's not the case for Instagram posting.

"Language learning is a goal people have in and of itself, and so having a badge and being rewarded for doing that, I'm intrinsically happy about that badge," Barasch said. "But to post on Instagram, I'm not like, 'Wow, I'm a great poster.'"

The trade-offs are that I'm putting myself out there. I might not get a lot of likes. People might judge me. There are so many social dynamics

Barasch said people seeing their own little badges may help in the short term, but it's hard to imagine a long-lasting impact unless it comes with some other perk or reward.

"The trade-offs are that I'm putting myself out there. I might not get a lot of likes. People might judge me. There are so many social dynamics," Barasch said.

A spokesperson for Meta acknowledged that the tools wouldn't be useful for every creator but said they'd seen them help creators who are just getting started and that, overall, Instagram wanted to do more to give creators guidance to achieve their goals. On the gamification front, the spokesperson said the "last thing" the company wanted to do was add more pressure on creators and emphasized that the features were optional, private, and relatively low stakes.

"This is very much a feature that's meant to help creators set goals within the app since we see creators already doing this on their own when they set their own personal challenges," the spokesperson said. "We want to help guide creators with the right goals and milestones that we believe will help them succeed on the platform."

Ultimately, the Instagram badges aren't the end of the world. At best, they're a nothingburger. At worst, they seem a bit lame and add to the vibe that Instagram is becoming a platform for olds. Grant sent me a screenshot of her achievements, none of which she has earned yet, and noted she'd never looked at them before I asked her about them. I texted my most Instagram-aware friend — who has a business account — to ask about her badges, and she sent me a screenshot of something different because she didn't know what I was talking about.

The Instagram badges aren't widely available for all users yet, and a spokesperson for Meta said they had nothing to share on whether they eventually would be. In the meantime, the badge thing seems pretty neutral to negative. Of all the achievements to care about, posting a story seven days in a row isn't a particularly aspirational milestone, and it's hard to gamify a social-media landscape that is already, by and large, a game.

Emily Stewart is a senior correspondent at Business Insider, writing about business and the economy.

• A Business Insider analysis looked at what qualifies as middle class across the US.
• Utah, Idaho, and Alaska have the highest share of residents in the middle class.
• Meanwhile, New York, Massachusetts, and Montana had the highest percentages of lower-class residents.

These three charts show just how many Americans in each state are lower, middle, and upper class — and what income in takes to qualify for each.

A Business Insider analysis of US Census Bureau data reveals that while 52.7% of Utah's population falls in the middle class, just 42.3% of New Yorkers are middle class. Pew Research Center defines being middle class as earning between two-thirds and double each state's median income.

In Texas, that's between $48,200 and $144,600, and in Minnesota, middle-class residents make between $54,900 and $164,700.

Americans often debate who truly belongs in the middle class. According to the Census Bureau, the real median household income nationally was $74,580 in 2022. Still, the median income per state can be as high as $101,000 and as low as $52,700, meaning that being middle class in one state could be either lower or upper class in another state.

Even those who mathematically fall into the middle class may not truly feel it. Many on the lower end of the middle class are particularly worried about having enough to meet all their daily needs while also saving for retirement. Some families have recently told BI that having over six-figure household salaries isn't enough, especially given the costs associated with raising kids.

Meanwhile, even for households making well into the six-figure range, many so-called HENRYs — or high earners, not rich yet — have enough for their daily expenses but feel like their savings are inadequate in case of an emergency or job loss. Many splurge on what matters but feel constrained, often putting off having kids or buying a home for when they feel more financially stable.

Only three states have half of households in the middle class: Utah, Idaho, and Alaska. States including Delaware, Wisconsin, and Wyoming have close to 50% in the middle class.

On the whole, the Midwest was relatively close to half, suggesting more households in these states are clustered around the median with less income dispersion than larger states.

On the flip side, New York, Louisiana, DC, and Massachusetts were all below 44% of households in the middle class, meaning that more residents fall into either upper or lower classes.

The South, on the whole, had the lowest median household incomes, with most in the mid to high $50,000s. States in the Northeast and Mid-Atlantic like New Jersey, Maryland, and New Hampshire were mostly in the high $80,000s and low to mid $90,000s.

New York, California, Connecticut, and Virginia had among the highest percentages of upper-class households in the 19% to 21% range. Most states were in the 17% to 18% range, though Alaska, Utah, and Idaho were all below 15%.

To be upper-class in states with the 10 highest median incomes, households must make above $178,300 — and must make above $202,000 in Washington, DC. Mississippi has the lowest income needed to be upper class at $105,400, while West Virginia was $108,600.

These Southern states also have a higher percentage of lower-class households overall compared to other states. New York had the highest percentage at 36.8%, followed closely by Massachusetts, Montana, and West Virginia. Hawaii also had a particularly high percentage at 36.2%.

Meanwhile, some Western states had percentages as low as 32.5%. Utah, Idaho, and Colorado were in the bottom five for this metric.

Do you feel middle class? Did you move to another state where you can feel more financially secure? Tell this reporter why or why not at nsheidlower@businessinsider.com.

Larry Ellison's vision for the future of medicine crystallized for him in a doctor's office.

Oracle's billionaire cofounder needed medication to help manage his cholesterol. He said his "very fancy doctor," a molecular biologist, prescribed a statin called Crestor. The choice was informed by Ellison's age, sex, ethnicity, and family history. But it was still, Ellison realized, just "a pretty good guess."

Which got him thinking: What if, instead of guesswork, doctors could lean on generative AI to comb through a patient's medical records, along with those of millions of other patients? With such a massive database, doctors could spot the warning signs of disease faster, reduce the need for trial and error, and make better-informed decisions about treatment.

Ellison told this story last fall at Oracle's CloudWorld conference in Las Vegas. At 79, Ellison cut a trim figure in a black T-shirt, with a visage that hinted at significant investments in antiaging. The moral of the story seemed to be that whatever the world's fifth-richest person demanded for himself could ultimately benefit everyone.

That was the promise of Cerner, the medical-records company Oracle bought in 2021 for $28.3 billion — Oracle's biggest acquisition. At the time, Cerner managed the electronic health records for a quarter of all American hospitals, including those run by the Pentagon and the Department of Veterans Affairs. Ellison's plan was to pump all that medical data into Oracle's AI models and develop an EHR of the future.

"You have this wealth of data that will help doctors make much better decisions of what therapeutics to give you, and that will deliver better outcomes at a much lower cost," Ellison said onstage in Las Vegas, adding, "I'm not sure there's anything we're working on here at Oracle that's more important than this."

There was just one problem: Cerner was a total mess. While Ellison was fixated on the wildly exciting possibilities of marrying Cerner's medical records with Oracle's technology, Cerner was failing at even the most elementary tasks of data management. The company's rollout at the VA, which serves 9 million vets, had been a slow-moving catastrophe. One feature of its electronic records system had caused more than 11,000 orders for medical care to disappear into an "unknown queue." As a result, thousands of patients didn't receive the treatment their doctors had ordered. VA staffers were left in what one hospital leader called "a constant state of hypervigilance and distress" as they scrambled to retrieve and reenter the missing orders, which wound up harming 149 patients. Even worse, errors in the system's underlying design were contributing factors in three deaths.

I'm not sure there's anything we're working on here at Oracle that's more important than this.
Larry Ellison

Cerner's electronic records, in short, were a deadly disaster for the VA. Never mind the futuristic, AI-driven healthcare system Ellison envisioned. In purchasing Cerner, Oracle had saddled itself with a huge liability. The company found itself in a race against time to fix the broken and dysfunctional system it had inherited from Cerner — before more veterans were injured or killed.

Ellison first approached Cerner about an acquisition two decades ago.

It was the mid-2000s, and the healthtech sector was red hot. The RAND Corporation had released a report estimating that the mass digitization of medical records would cut healthcare costs by $81 billion a year. While some saw the prediction as excessively rosy — it was paid for, in part, by Cerner — the report helped pave the way for a massive infusion of federal stimulus dollars to supercharge the adoption of electronic health records at American hospitals. Never mind that EHRs were more cumbersome than advertised; RAND would later conclude there were barely any savings. The promise of bringing hospitals into the digital age was deemed too important to put off.

Meanwhile, Big Tech was starting to invest heavily in healthcare IT, and Oracle wanted in.

Neal Patterson, Cerner's cofounder and its CEO at the time, was not impressed with Ellison's pitch. Like other executives at the company, he was distrustful of Silicon Valley. Big Tech, they felt, brought more chutzpah than expertise to the healthcare table. For years executives at Cerner passed around an internal slide that cataloged tech investments in healthcare and the raft of embarrassing exits by companies like GE and Siemens. Patterson rebuffed Ellison's advances, according to a former Cerner executive familiar with the discussions.

A decade later, Cerner scored a huge win. In 2015, it beat out Epic, its main competitor, for a $4.3 billion contract to handle electronic health records for the Defense Department. Two years later, it landed a similar contract for the VA, worth an estimated $10 billion, without even having to bid. The thinking was that giving both contracts to a single company would ensure seamless care for service members, especially in the period immediately after they're discharged, when they're most vulnerable to mental illnesses and substance-use disorders. "I wanted to move towards a single instance of an electronic record with the Department of Defense to make sure that this issue was resolved finally, once and for all," says Dr. David Shulkin, who served as the secretary of veterans affairs at the time.

But Cerner didn't have long to savor its victory. A month after it landed the VA contract, Patterson died of cancer. A bruising succession process ensued. Cerner was losing ground to Epic, and its stock had plateaued. In 2019, the activist investor and private-equity shop Starboard Value gained seats on Cerner's board, putting public pressure on the company to turn things around.

What's more, taking on two vast government systems turned out to be overwhelming. In the fall of 2020, as Cerner's inaugural system was rolled out at the VA health center in Spokane, Washington, things began to go wrong. Doctors and nurses complained that the system was slow and difficult to use, requiring them to spend more time inputting data and less time caring for patients. "You're spending all your time messing around on Cerner and taking like 10 minutes with your patients," one VA provider says. While VistA, the bespoke EHR that Cerner had replaced, was outdated and vulnerable to cyberattacks, it was generally reliable and user-friendly. With the new system, completing basic tasks was maddeningly complex, impeding the care Cerner was designed to streamline.

As records disappeared into Cerner's unknown queue, patients with serious illnesses went untreated. In one instance, a scathing report by the VA's inspector general said, a provider entered an order for a homeless patient at risk of suicide to receive follow-up care, but the order never went through, and the patient later had to be hospitalized after threatening to kill himself.

The unknown queue had been designed to capture orders Cerner couldn't deliver to the intended location. But the system didn't send an alert when this happened, and the inspector general found that Cerner had failed to train VA staff on the feature, putting the burden on the VA to identify the issue and request a fix. One VA leader compared Cerner's attitude about the missing medical orders to the post office stuffing "undeliverable mail behind a bush instead of placing them back in your mailbox."

While the VA had promised to "do right by both veterans and taxpayers," the switch to Cerner was doing harm. One Spokane veteran, Charlie Bourg, blames Cerner for a delay in getting a prostate-cancer diagnosis, after a referral was diverted into the unknown queue. By the time the mistake was discovered, Bourg's cancer had spread to the lymph nodes between his spine and stomach, and it was too late to do anything about it. The cancer was terminal. "I never gave the VA permission to gamble with my life," Bourg says.

As Cerner was rolled out to more VA and Defense Department health centers, their shared activity and data — more than Cerner had ever handled at once — pushed the company's aging hardware to a breaking point. And since its system wasn't on the cloud, Cerner was struggling to meet the increasing demand. It had agreed to process tens of millions of crucial medical records, but it couldn't handle the subsequent deluge of data.

The longer Cerner's system ran, the more the problems piled up. By the time Oracle approached the company for the second time, Cerner was no longer in a position to say no.

IIn the years after Ellison first approached Cerner, he became preoccupied with matters of health and longevity. "Larry and I both share a sadness with all the folks we've lost to cancer," says Marc Benioff, the Salesforce CEO and longtime Ellison protégé. "He wants to extend human life and help people live healthier lives. He's quite advanced in age, and aging, and may not be able to benefit himself."

Medicine has been a lifelong obsession for Ellison. He once thought of becoming a doctor, but he didn't stick with school long enough to get a degree, much less a medical degree. Once he became wealthy, he started to view death, as his biographer Mike Wilson put it, as "just another kind of corporate opponent he can outfox."

Ellison views healthcare as "a remarkably backward business," says Dr. David Agus, a renowned oncologist who met Ellison in the mid-2000s, right around the time Oracle first approached Cerner. Agus was treating Ellison's nephew for prostate cancer, and he'd later treat the Apple cofounder Steve Jobs, Ellison's close friend, who died in 2011. Since then, Agus and Ellison have collaborated on healthcare investments worth hundreds of millions of dollars, including the Ellison Institute of Technology and Sensei, a wellness-retreat company that includes a health utopia built on the Hawaiian island Ellison owns almost in its entirety.

"We've met with hospital administrators, researchers, and doctors," Agus says. "He commits to them, 'I can solve this problem.' And he does. Larry actually solves the problem, not just gives money."

Ellison saw medical records as another area where he could solve a problem. EHRs stand at the center of modern healthcare, used for storing a patient's medical information, ordering follow-up appointments, calling in prescriptions, and more. And yet the systems are treated mostly, as Ellison likes to say, as a "bag of words" — you can't easily extract data from them on a mass scale. All that medical information was going to waste.

Epic may have been a more obvious target for Oracle, since it had a larger share of the market and dominated among large hospitals and research facilities. But Cerner, the go-to EHR for small and midsize hospitals, had a quality that would have appealed to Ellison: It was widely seen as taking a more relaxed approach to data privacy. The company was investing in the technology infrastructure to help hospitals share data with one another — and with third parties.

As it happens, the pandemic strengthened Oracle's case for scooping up Cerner. In the race to defeat the coronavirus, both companies were afforded greater latitude in handling patient records, including those that fall under the Health Insurance Portability and Accountability Act. That would enable Oracle to get started on Ellison's EHR of the future right away. Buying Cerner would also help the tech giant compete with Amazon and Microsoft in the massively profitable cloud-computing business and establish a foothold in the healthcare industry, which, at $4.4 trillion, accounted for roughly 18% of the American economy in 2022. It seemed like nothing but upside for Oracle.

Oracle and Cerner announced the deal in December 2021, and the acquisition was finalized on June 8, 2022. Oracle believed it was finally in a position to fulfill Ellison's dream of revolutionizing modern medicine. In reality, it had acquired a high-tech filing system that couldn't even perform the simplest of filing tasks.

The stark reality of what Oracle had just paid for was made clear six weeks after the deal closed, when the tech giant was summoned to Washington, DC, for a grilling before the Senate Committee on Veterans' Affairs.

In the months since Oracle had announced its intention to buy Cerner, the mess at the VA had only gotten worse. Outages were increasingly common, and one Cerner executive says the entire system was on the verge of failing: "We were going to go off a cliff and die." The system was considered so dangerous that its rollout to the remaining 166 VA medical centers had been put on hold. Senators listed 36 fixes they expected Cerner — now Oracle — to address before additional sites could make the switch.

Oracle, incredibly, claimed it hadn't been aware of the magnitude of the challenges facing Cerner when it made the biggest acquisition in its history. "I would say there's always things that you discover after the fact," Mike Sicilia, the Oracle executive leading Cerner, told the irate lawmakers. "You know, we certainly had read the press, and we certainly had read things that were publicly disclosed. But there's nothing like owning something to fully understand what's going on."

Still, Sicilia assured lawmakers that Oracle intended to turn things around. The company, he said, had already shifted its top talent, including senior engineers, to work on the VA project. Within nine months, Oracle would move the project onto the cloud, remedying bugs and cutting costs. It would also design a state-of-the-art program for pharmacy, a trouble-ridden area for the project. "Everything here is fixable and addressable" and Cerner would soon be the "gold standard" among EHRs, Sicilia said, adding, "We intend to exceed expectations."

Oracle, incredibly, claimed it hadn't been aware of the magnitude of the challenges facing Cerner when it made the biggest acquisition in its history.

Behind the scenes, Oracle was throwing resources at the situation. To address the raft of blackouts and slowdowns, Oracle installed expensive new hardware and made tweaks that stabilized the system and reduced outages dramatically, the Cerner executive told BI. Ellison was directly involved, holding a monthly meeting with 50 or 60 executive and senior vice presidents in the Oracle Health unit to review incidents and brainstorm solutions, according to a high-level employee who attended the meetings. "Oracle is still learning what they have actually acquired from Cerner," an Oracle executive concedes.

But as Sicilia was trying to assuage concerns on Capitol Hill, a fresh disaster was unfolding at the VA. Only this time, it was happening on Oracle's watch.

Anthony Jones Jr., a 28-year-old Ohio native who had served in the Navy for four years, had a history of post-traumatic stress disorder and suicide attempts. In May 2022, he was due to see a VA psychologist, but he failed to show up.

At the time, the Columbus VA had just switched over to Cerner. One feature of the EHR was that if a vet missed an appointment, the no-show would trigger VA staff to follow up. For mental-health cases, VA rules require that vets get three calls, on separate days, followed by a letter. The extra layer of precaution is vital because vets are far more likely to die from suicide or a drug overdose than nonveterans. But because of a design error, that didn't happen. In Jones' case, the record of the no-show "just kind of evaporated," says a Columbus provider familiar with his care. Jones got two calls, but not a third.

Six weeks later, on July 4, Jones was found unresponsive in the shower with the water running. The coroner's report noted that numerous empty cans of inhalants were found scattered around the apartment.

By the time of Jones' death, Oracle was fully in charge of the electronic records system — but it didn't discover and fix the error until August. This led to the VA sending out 70,000 letters to veterans who might have been affected by the error, including 24,000 in central Ohio alone, according to a letter to lawmakers from Donald Remy, the VA's deputy secretary at the time — a copy of which was obtained by BI.

The VA's inspector general later issued a report on the scheduling error that described a case mirroring Jones'. It concluded that "the lack of contact efforts may have contributed to the patient's disengagement from mental health treatment and ultimately the patient's substance use relapse and death."

In another case linked to the same scheduling error, a vet with cirrhosis of the liver failed to appear for an appointment with staff to discuss his drinking, according to a provider familiar with his care. When the vet didn't show up, VA staff — unaware of the scheduling error — left a single voicemail. The vet died in late August of complications from liver damage.

The vet's disease was already so progressed that it's unlikely a single appointment could have made the difference. But because of Oracle's oversight, there's no way to know if better follow-up could have saved the veteran's life.

"Could you imagine in a case like that where we did all the outreach we could have — but that one call," the VA provider says. "And then having to tell that family member he should have got one more call."

A month later, there was another death in Columbus, this time linked to an error in Cerner's pharmacy app. Antibiotics ordered for a vet who had been treated in a community hospital didn't arrive. When the vet's family called the VA pharmacy to see what was holding it up, they were given a tracking number — confirming, it seemed, that the medication had been shipped. But according to Remy's letter to lawmakers, the Cerner EHR had generated a bogus tracking number; the medication had been slated for pickup. The vet never received the medication, and his condition worsened while at home. He died of hypoxia in late September.

Problems with ordering medications were widespread. When Cerner was first deployed in Columbus, delays kept patients with severe schizophrenia waiting for their medication, a Columbus provider says. In the old system, ordering the shots they needed took about two minutes. It required 30 or so steps — and making a single mistake meant starting over. Vulnerable patients, already resistant to treatment and prone to stress, were kept waiting. In one case, staffers had to retrieve a patient who'd bolted for the parking lot bus stop. "By the time we go through all of this difficulty of ordering the medication — which should be a simple thing — the patient can't hardly take it and they go running outside," the provider says.

After Oracle took over, it took months for improvements to be made — and the orders still take 10 minutes to complete.

Nearly two years after its blockbuster deal with Cerner, Oracle says it has made thousands of improvements. "Our veterans and the people who care for them deserve a world-class EHR system," Seema Verma, the head of Oracle Health and Life Sciences, said in a statement to BI, "and Oracle is delivering it."

The VA also insists it is addressing the problem. "We know from listening to both veterans and VA clinicians that the electronic health record is not meeting expectations — and we're holding Oracle Health and ourselves accountable to get this right," says Dr. Neil Evans, who heads the VA's EHR modernization office. The rollout of the system remains on pause, and the VA will impose higher penalties on Oracle if the company fails to meet performance targets.

But Oracle is still struggling to stabilize the system it bought. The company hasn't fully moved Cerner onto the cloud, as Sicilia promised. While outages have decreased, the VA says they remain "an area of significant attention." According to one Columbus provider, the system went down for 90 minutes in late April, forcing staff to write notes by hand. "Ninety minutes is an eon in clinical time," the provider says. "No scheduling, charting, ordering, reading — nothing."

And while Oracle said it largely resolved the issues with the unknown queue within months of buying Cerner, two VA clinicians described a case from last fall where the disappearance of lab results caused a delay in a patient receiving critical medication. The records, they suspect, went into the unknown queue.

Ellison continues to push for his EHR of the future. But one Oracle executive described the VA contract as a "shackle," absorbing time and attention from Ellison's grander vision for the database he spent so much to purchase. And while Ellison is pushing the AI envelope, there's a chance Oracle could lose a lot of the health data that made Cerner such an attractive bet in the first place. Cerner has continued to lose ground to Epic, its main competitor. Intermountain Health and UPMC, two massive longtime Cerner clients, recently announced they were switching to Epic.

EHR deployments can cost hundreds of millions of dollars and require extensive training, making hospitals reluctant to bet on a company struggling to get the job done. "Folks feel like Cerner is circling the drain," says Sara Vaezy, a chief strategy and digital officer at Providence, a health system in Washington with more than 50 hospitals. "You don't want to pick a dud that you're going to have to replatform in a few years because they don't exist anymore or their product is so bad."

One Oracle executive, who spoke on the condition of anonymity, acknowledged that many of Cerner's clients were unhappy, in part because cuts to Cerner's workforce had left them with less day-to-day support. "There's not a whole lot we have to tell clients other than please hang in there," he says.

A growing chorus of lawmakers has been calling for the contract to be scrapped. "It's a political and governmentwide failure," says Ed Meagher, a former top official at the VA. "The DOD made a terrible decision, and then that forced a terrible decision on the VA."

It's clear that shifting a vast government-run system like the VA over to a standard EHR designed for the private sector proved far more complex than either Cerner or the VA anticipated. The EHR that Cerner replaced, VistA, was built specifically for the VA, and it was constantly tweaked and upgraded to suit the needs of individual providers and hospitals. The VA brought this mentality to the Cerner project, flooding the company with requests for special customizations — and Oracle has grown so frustrated that it has stopped taking on individual requests that haven't been formally contracted.

Within Oracle's health team, morale has suffered. "Morale is at an all-time low," an Oracle-Cerner manager says. "We have so much important work to do. Everybody's velocity is lower because basically everybody is depressed or upset."

In Spokane, where Cerner was unveiled, it's not clear that things have gotten any better since Oracle took over. During a recent visit to the VA, Charlie Bourg — the vet whose referral was lost in the unknown queue — noticed that the computer was down and that his providers from different departments seemed to have trouble communicating about his case. "I had to watch them struggle," he says.

Bourg knew the issues to be on the lookout for. He and another vet, Charlie Monroe, have become something of a rapid-response team for vets in Spokane and elsewhere. Known to providers and patients as "the Charlies," Bourg and Monroe are among the first to know when a new problem with Cerner is discovered. Lawmakers call them to find out what's going on. Relatives call when they need help advocating for a patient. "People come up to us out of the blue," Monroe says. "They know who we are. 'Can you do something about this? Can you talk to somebody about this?' No. Yeah. Maybe."

In February, the Charlies helped connect the family of a recently deceased vet with Rep. Cathy McMorris Rodgers, a congresswoman representing Spokane who has called for the termination of the VA's contract with Cerner. Based on initial information from the VA, the vet's daughter was concerned that Cerner might have led to his being given the wrong antibiotic, contributing to his death from sepsis.

Bourg and Monroe are about as different as two vets with long white hair could be. Bourg is soft-spoken and has a flat delivery, even when the topic turns to how much time he has left and how much he worries about his wife and grandkids. (Last December he sued the VA and Oracle for an undisclosed amount.) Monroe, who wears the yellow logo of the Seabees, the Navy's construction regiment, is loud and likes to say he's the better-looking of the two. "We're just two veterans that got involved with this shit because we were screwed over," Monroe says.

When Oracle entered the picture, the Charlies were confused by the company's name, believing it to be a video-game company. They don't know much about Ellison's grand vision for revolutionizing medicine. They just want vets to get the high-quality care they deserve.

Late last year, not long after Ellison's appearance at CloudWorld, the Charlies received a surprise invitation to meet with the VA's leadership in Spokane. Bourg says meetings like that take a toll on his body and mind. Back in 2022, the two had traveled to Washington to meet with lawmakers only to return feeling like it had been a waste of time. "I was totally mentally and physically exhausted," Bourg recalled, "and it still didn't do anything."

Bourg expected to come out of the Spokane meeting feeling the same way. Instead, he delivered a simple message to the assembled leaders. Given Oracle's track record of botched care, he said, there's only one thing for the VA to do: put an end to a contract that has proved so disastrous for so many veterans before someone else gets hurt.

"If they aren't telling me they are shutting it down," Bourg said, "there's nothing to say."

Ashley Stewart is a chief technology correspondent at Business Insider.
Blake Dodge is a correspondent at Business Insider covering technology in healthcare.

• Walmart said last week it will lay off several hundred workers and relocate others.
• "It's a reversion to what Walmart was known for a few years ago," an expert told BI.
• But unlike some recent episodes of "quiet firing," there appears to be more at play for Walmart.

Walmart's announcement on May 14 that it'll lay off several hundred workers and relocate others to one of three main campuses is another example of a big company reversing a pandemic-era embrace of remote work. 

For Walmart, it's also a return to what it knows and what helped build it into the world's largest retailer: centralized control. 

Founder Sam Walton famously built his own logistics network from the ground up to avoid relying on another carrier to serve his sprawling empire of stores. And the company has reportedly regularly flown senior executives on corporate jets from its Arkansas HQ to regions of the country where their stores are located, helping them, in some cases, avoid staying overnight.

Now, the retailer is requiring hundreds of previously remote employees to move within commuting distance of the company's Bentonville, Arkansas, main office or hubs near New York and San Francisco.

"It's a reversion to what Walmart was known for a few years ago," said Nelson Lichtenstein, a research professor in the history department at the University of California, Santa Barbara, who focuses on labor and has studied Walmart. 

"They were, in a way, very centralized. Executives lived in Bentonville," he told Business Insider. 

'We make decisions faster, we're more creative'

CEO Doug McMillon told investors on May 16 that the company's culture is stronger when workers are together. "We make decisions faster, we're more creative, and we help develop the next generation of talent." 

Walmart's chief people officer, Donna Morris, commented similarly in a memo announcing the layoffs and relocations earlier that week. She wrote that working in an office would help workers collaborate, innovate, and "move even faster." Walmart didn't comment further to BI at the time.

Morris' memo also hinted that the decision was years in coming, referring to a February 2022 move to bring Home Office employees back into the offices after pandemic lockdowns. Still, some employees continued working remotely, and several satellite offices remained open in cities like Atlanta, Dallas, Toronto, and Seattle.

Of course, Walmart has invested heavily in having more people come to work in-person in Bentonville. Opening in phases through 2025, the company's new 350-acre campus will feature modern offices, restaurants, childcare facilities, a hotel, bike paths, and multiple lakes.

A new normal

The company's decision also represents an about-face from just a few years ago when Suresh Kumar, Walmart's global chief technology officer, wrote on LinkedIn about a shift toward remote work for Walmart Global Tech. 

"We believe the future in tech will be one in which working virtually will be the new normal, at least for most of the work we lead," Kumar wrote in 2021. 

Following the layoff news, Kelli Oakes wrote on LinkedIn that she'd lost her finance recruiter job for Walmart and Sam's Club after having been hired as a permanently remote worker nearly three years ago.

"I'm devastated, embarrassed, sad, angry, defeated, and hurt," Oakes wrote. 

She said the company offered her the chance to apply for a new job in Bentonville, the Bay Area, or Hoboken, New Jersey. "Truthfully, after a home purchase and life-threatening post-birth complications, my family cannot afford to relocate now or in the near future," Oakes wrote. She said she'd returned from maternity leave two months ago and purchased a home in South Carolina eight months ago.

Even workers whose jobs are technically safe from cuts are having to weigh the cost of uprooting their lives to move to Northwest Arkansas or an expensive coastal city.

It's not all about quiet firing

One remote worker told BI he and several colleagues were offered "generous" relocation packages to move to the Bay Area, but accepting one would take him away from his family and result in a more than 50% increase in the cost of living. He asked BI not to use his name as he is still employed and not authorized to speak to the media. BI verified his identity and employment at Walmart.

"Five months to move is not a lot of time to close up your life," he said.

He also said he doesn't think the company is using this RTO mandate as a cover for achieving cost savings through workforce reductions, commonly referred to as "quiet firing," but that it's more part of Walmart's ethos.

Lichtenstein, the UC professor, said Walmart's decision isn't surprising given that many corporate leaders appear to have an impulse to gather people in one place. 

"You're able to sort of pop in on them. It's a form of supervision and control. CEOs feel that even if statistics show that someone working at home is just as productive, they want them there," he said. "One of the hallmarks of Walmart efficiency was there was kind of close supervision from the stores on up." 

Indeed, many companies have settled on having workers back in the office at least some of the time, and while many are pushing for more time in-office, there's an increasing acceptance of hybrid work. A recent survey of big-company US CEOs found about one-third expect their workers will be back in the office five days a week in the next three years. The study by KMPG US a year earlier found that nearly two-thirds of CEOs thought offices would be full every weekday. 

Yet not all workers are happy about resuming — or starting — a commute. A recent poll by the resarch firm Gartner found that return-to-office mandates were a factor in pushing 36% of workers seeing senior-level jobs to look for a new role. 

For the remote worker BI spoke with, the next few weeks will be filled with uncertainty.

"I don't have a problem going to an office, but to be forced to leave family, pack up, and move, all in such a short timeframe," he said. "It's going to be a tough decision."

If you work for Walmart and were affected by this decision, please contact reporter Dominick Reuter via a non-work email and device or text/call/Signal at 646-768-4750. Responses will be kept confidential.

• Kyle Rice supercommutes from Delaware to New York for his job at an EMS software company.
• The commute takes about two hours each way and costs $1,510 monthly for Amtrak and PATH trains.
• Rice says it's worth it because he earns a high salary but enjoys lower living costs in Delaware.

This as-told-to essay is based on a conversation with Kyle Rice, a 38-year-old EMS provider based in Willmington, Delaware. The following has been edited for length and clarity.

For 15 years, I worked as a critical care paramedic. I spent between 12 and 24 hours at a time in an ambulance providing, direct patient care. I loved this job.

But I'm very much of the mindset that when a good opportunity comes your way, you should take it. I came across a job on a job board as a protocol architect for a project manager at an EMS software company. This job interested me because it involved working in the tech side of healthcare.

The only catch was that the job was based in New York City and required in-office workdays five days a week. I live in Wilmington, Delaware, with my wife and two kids — 125 miles from the office. We own our house. Even though this job seemed like a dream, I wasn't in the position to uproot my life for it.

I met most of the qualifications listed in the job description, so I applied anyway

I knew it only took around two hours by train to get to NYC from going there on vacation, so the idea that I could commute to work for this job didn't seem far-fetched.

The job description stated they were looking for someone living in New York or New Jersey, but when I calculated my commute versus someone living in Long Island, it came out to be roughly the same amount of time. When asked about my commute during the second interview, I shared my plan to take the Amtrak train, transfer to a subway, and be in the office by 9 a.m. I was offered the job and started supercommuting in February.

It takes me around 2 hours door-to-door

I leave my house at 6:15 a.m. and drive eight minutes to the train station in Wilmington to catch the 6:33 a.m. Amtrak train to Newark Penn Station. The ride is around an hour and 37 minutes.

After that, I get on the PATH train to the World Trade Center, which takes 30 minutes. I step outside the Oculus at around 8:35 a.m. and walk a block to my office. If there are no delays, I'm often one of the first to arrive in the morning.

I do the reverse commute at night and am on the couch by 7:30 p.m., which gives me plenty of time to be with my kids, eat dinner, and do some chores before starting it all again the next day.

The transportation costs me $1,510 a month

I spend $1,400 on an unlimited Amtrak pass every month, which allows me to ride the train twice daily for $35 a ride. I also have an unlimited PATH train card, which costs $110 a month.

I do have commuter benefits through my job. We can use pre-tax income to purchase the commuter cards, and there's a discount built in.

It might seem like an expensive commute, but it's worth it.

I earn more and save more by working a NYC job

I'd never consider relocating to NYC because it wouldn't be smart financially. This job pays considerably more than a similar one in Delaware. This new job allowed me to double my salary — I now make six figures.

I don't have to worry about the high cost of living in NYC. The average one-bedroom in Manhattan is $4,443, three times my mortgage of $1,400. I live in a suburban area with all the benefits of urban pay.

Plus, I love spending time in NYC and experiencing the culture, food, and diversity. I find time to enjoy the city on lunch breaks or before I head into the office.

The hardest part is giving up family time for the commute

The hardest part of this commute is the time commitment that takes me away from my family. My wife is amazing and took on the burden of being home with our two kids under four. She handles many duties that I can't do, all while working full-time in law enforcement.

When I was working as a paramedic, I'd be off for a few days after my shifts. This allowed me to help more around the house and spend time with my kids. The opportunity and the higher pay make this worth it for now.

I like to make myself comfortable and enjoy my time on the train

I pack an inflatable neck pillow, blackout glasses, and earbuds. There's WiFi on the train so I check emails, read the news, listen to podcasts, or sleep. Sometimes, I'll sit in the dining car just to talk to other people, which is fun and helps pass the time.

Sometimes, there's the added component of stress if the train is delayed or going slow because of signal issues, which can add hours to the commute. Now, I have backup plans if there are delays. I've been late for work on a few rare occasions, but my boss understood.

I only have to go in 2 days a week now

Recently, my job has shifted its requirements, and I only have to go into the office twice a week, but I usually go in more for in-person meetings.

I don't think I'll ever tire of watching the sunrise as the train pulls into Newark or seeing the Manhattan skyline off in the distance. Whenever the commute frustrates me, I remember how grateful I feel that I can pass through a handful of states on my way to work. I just stay present on the ride and just enjoy the view.

• The Google Doodle is a piece of art that temporarily replace the logo on Google's homepage.
• The first-ever Google Doodle was created as an out-of-office message for Google's founders.
• Google Doodles are now much more complex, and celebrate both major and obscure events and figures.

Throughout Google's 25-year history, the Google Doodle has grown into an iconic and beloved way for the search engine to celebrate holidays, historical moments, or notable figures.

A Google Doodle is a themed illustration or artwork that temporarily replaces the Google search logo on the search engine's homepage. Over time, the doodles have been elevated from simplistic drawings to elaborate artworks or even interactive games that both inform and entertain the billions of people who use Google across the world.

In the past, the Google Doodle has marked events like Pi Day, the 30th anniversary of the world wide web's creation, the 136th birthday of author Virginia Woolf, and even Google's own birthday (September 27, 1998).

The Google Doodle is also known for drawing attention to more obscure figures and events: It has celebrated days like the 96th birthday of David Warren, who invented the black boxes used in aircraft; the 80th anniversary of the opening of the Moscow Metro, and the 121st anniversary of the publication of the first Japanese railway timetable.

Google typically sticks to historical figures or events for its doodles. Although Google Doodles sometimes appear for celebrations rooted in a particular religion, like Holi, Tu B'Av, or Valentine's Day, the company eschews including religious symbols in those illustrations. This official policy means you won't see designs for major holidays like Easter or Kwanzaa.

If Google Doodles aren't your thing, you may be out of luck. Google Doodles can't be removed, hidden, or disabled. You'll just have to wait until the next day when it reverts to the standard Google logo.

Here's what to know about where the iconic Google Doodles come from, how to make one, and how they've changed over the years:

What was the first Google Doodle?

The very first Google Doodle was created by Google's founders in 1998. The illustration served as an out-of-office message for Larry Page and Sergey Brin to denote that they were attending the Burning Man festival.

But over the years, the Google Doodle has evolved to be more than just a simple logo and transformed to be interactive and fun.

How to make a Google Doodle

As part of Google's computer science education offerings, Google offers a short tutorial on how users can program their very own Google Doodles.

But if you're a student between kindergarten and grade 12, Google holds a Doodle for Google contest for students to create their own Google Doodle artwork and submit it for a chance to win awards, scholarships, and Google hardware and swag. The winner gets to have their artwork featured on Google's homepage for 24 hours.

To enter the student competition, create your artwork out of any materials you like (Google even accepts pieces made from "crayons, clay, to found objects") and write an artist's statement. You can submit your Google Doodle by mail or upload it as a jpg or png file.

The 2023 Doodle for Google winner was Rebecca Wu, a sixth grader from Washington DC. Rebecca's Doodle, "My Sweetest Memories," ended up on the Google homepage and reflected her gratitude for her sisters and the memories they've created together.

What is a Google Doodle game?

Google has occasionally included interactive games in its Google Doodles. Some like Snake, have been simplistic classics. But others are elaborate and complex.

For instance, Google Doodle chose to commemorate the fictional time traveler Dr. Who by celebrating the 50th anniversary of the TV series.

The Doctor Who Google Doodle launched in 2013 worldwide and featured an interactive game that was notoriously difficult to complete.

Google has come a long way, and now has over a dozen interactive Google games from past doodles that you can play. From Pac Man to Rubik's Cube, here are our top 10 Google Doodle Games:

• Pac Man
• Snake
• Dr. Who
• Garden Gnomes
• Scoville
• Quick, Draw!
• Halloween
• Fischinger
• Pony Express
• Cricket

To find and play these games, simply search them up in Google.

Quick tip: Google archives old Doodle games on its dedicated Google Doodle page. You can browse the Google Doodle archive anytime to find old games and doodles. There's even a tool to enter your birthday and see the doodles Google has published on that day in past years.

• SpaceX CEO Elon Musk was in Bali, Indonesia, this Sunday.
• The billionaire was there to launch his company's Starlink satellite internet service.
• Musk ditched his regular attire of black t-shirts and suits for a green batik shirt. 

Billionaire Elon Musk was in Bali this Sunday, and boy, was he serving up some serious tropical swag.

The SpaceX CEO headed to Indonesia on May 19 where he launched his company's Starlink satellite internet service. As part of his visit, Musk visited a community health center where he was seen wearing a Javanese batik shirt.

"I think its really important to emphasize the importance of internet connectivity and how much of a life changer that it can be, and a lifesaver it can be," Musk told reporters at an interview on Sunday.

"If you have some goods or services that you wish to sell to the world, even if you are in a remote village, you can now do so with an internet connection," Musk said. "So it can bring a lot of prosperity, I think, to rural communities."

Musk's choice of attire is notable — he's often seen donning the typical suit and tie or black t-shirt during business trips or at his companies' product launches.

This time round, Musk went with a more localized choice, picking a green batik shirt for Bali. The term "batik" refers to an Indonesia technique of using wax-resistant dyes to design intricate patterns on clothing.

Musk, of course, is no stranger to Indonesia.

Musk's SpaceX has been working closely with the Southeast Asian country to bolster its internet connectivity. According to the World Bank, roughly 66% of the country's 280 million population uses the internet, although connectivity is poor in Indonesia's rural and remote areas.

And the green batik shirt that Musk wore on Sunday appears to be the same one he was gifted when he participated in Indonesia's B20 Summit in November 2022. The event is an official G20 dialogue forum that is targeted at business leaders.

Musk, who was unable to make the trip to Bali then, gave a virtual interview to Indonesian businessman Anindya Bakrie. Musk was seen wearing the same green batik shirt during his video call.

During the interview, Bakrie told Musk that the "batik bomba" shirt that they sent him came from a small village in Central Sulawesi.

"Thank you for this awesome shirt. That's great. I love it," Musk said.

Musk isn't the only billionaire who has been eager to embrace local culture while he's out travelling.

When Meta founder and CEO Mark Zuckerberg attended the Ambani family's pre-wedding celebrations in March, the billionaire wore tigress and flower-themed outfits that were made by Indian fashion designer Rahul Mishra.

"Love an Indian wedding," Zuckerberg wrote in an Instagram post then.

Representatives for Musk didn't immediately respond to requests for comment from BI sent outside regular business hours.