Here comes Amazon

With help from Arthur Allen (@arthurallen202), Rachana Pradhan (@rachanadixit) and Mohana Ravindranath (@ravindranize)

Editor’s Note: This edition of Free Morning eHealth is published weekdays at 10 a.m. POLITICO Pro eHealth subscribers hold exclusive early access to the newsletter each morning at 6 a.m. To learn more about POLITICO Pro’s comprehensive policy intelligence coverage, policy tools and services, click here.

HERE COMES AMAZON: The tech giants keep on trampling into medicine. Seattle tech giant Amazon announced Wednesday it’s got a new machine learning service — called Amazon Comprehend Medical — intended to help the health care sector understand free text contained in medical records.

Amazon says the information will be useful for clinical decision support, revenue cycle management, clinical trials, and population health, and will potentially save lots of clerical work stemming from the need to tag or structure prose.

“We’re able to completely, automatically look inside medical language and identify patient details,” including diagnoses, treatments, dosage and strengths, “with incredibly high accuracy,” Amazon exec Matt Wood told the Wall Street Journal.

Amazon said it has been working closely with Fred Hutchinson Cancer Research Center and Roche Pharmaceuticals.

eHealth tweet of the day: Christina Farr @chrissyfarr “It’s funny how all the tech companies have different competencies but seem to be roughly settling on very similar health care projects (e.g. medical record data & biomedical sensors)

Either:

1) They talk to the same people

2) These are what tech considers the ‘low hanging fruit’”

WEDNESDAY: Like everyone, your correspondent is sometimes rendered uneasy at the odd clairvoyance of the online ad industry — say, when it tries to foist mattresses on you just after you’ve bought a bed frame. Then again, your correspondent also takes pleasure from particularly ill-targeted ads. Like just today, when some ad attempted to sell a drug dealing with pain associated with menopause. Share anecdotes of poorly targeted ads at [email protected]. Discuss ads at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

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CMS DROPPING INTEROP HINTS: Agency administrator Seema Verma teased the forthcoming interoperability rule — saying it would come “over probably the next couple weeks” — in a breakfast with reporters Tuesday. She reiterated her emphasis on health insurers making their claims data more available to patients: “You’re going to hear more from us on that particular area.”

Verma also discussed the agency’s floating the possibility of making interoperability a condition of participation in Medicare.

“I think that’s much easier to some degree to consider for hospitals and for physicians where they were funded to essentially have the electronic medical records, a little bit more of a thorny issue I think for the post-acute providers where many, some of them, don’t have electronic medical records,” she said.

“I NEED HELP”: Thus spoke John Windom, the former military contract officer running the VA’s Cerner implementation, at a MITRE Corp.-hosted interoperability forum on Tuesday. Windom, who has been subject to skepticism because he lacked health, IT, or health IT experience prior to leading the military and VA EHR contracting processes, said he needs to hire 135 people to his Office of Electronic Health Record Modernization over the next six months, bringing its total staffing to 265.

“I need help. In no way have we completed our team,” he said. “I want to move ahead more efficiently and effectively, but that requires more expertise. If you think you add value to what we’re trying to accomplish, let me know.”

The record will deploy over 23 Veterans Health Administration regions going on line from 2020 to 2027. A total of 500 VA clinicians and other EHR users will attend eight separate sessions at Cerner HQ ending in May, he said, to go over the design of the Cerner instance (or version of the software) the agency plans to deploy starting next year.

Meanwhile, Lauren Thompson, leader of the VA/DoD Interagency Program Office, said she was setting up three governance bodies to step in when the two agencies have major disagreements over EHR implementation. She said this should satisfy congressional critics who, wary of years of failed VA-DoD IT coordination, have demanded a clear chain of command. VA Sec. Robert Wilkie and Defense Sec. Jim Mattis have said they’ll personally oversee the deployment, she added.

CONGRESS FEUDING: A pair of GOP grandees are feuding over the fate of a pair of health care bills, our colleagues Sarah Karlin-Smith and Sarah Owermohle report. Sen. Richard Burr has held up a bill overhauling over-the-counter drug regulations. That bill’s author, Sen. Johnny Isakson, has responded tit-for-tat by putting the brakes on Burr’s Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 ( S. 2852 (115)).

Burr’s bill is particularly pressing since funding and authorities for HHS’s preparedness functions expired in September. For cybersecurity watchers, the bill is asking HHS to author a report on defending the nation’s digital infrastructure in health care.

— Dems call for IG investigation in VA: Democratic Sens. Tammy Duckworth and Maggie Hassan issued a call Tuesday for the VA’s inspector general to conduct an inquiry into whether department officials violated federal policy in interacting with the so-called “Mar-a-Lago” crowd. The Government Accountability Office recently stated it was investigating the department and its relationship with those friends of the president.

PRIVACY DEBATE UNSPOOLING: The privacy debate stretched onwards Tuesday. Here’s a recap:

— California AG Becerra undaunted: California attorney general Xavier Becerra vowed to write privacy rules related to the state’s recent consumer privacy law, our Tech colleague Steve Overly writes. Chatter in Washington holds that there’s a possibility of federal privacy legislation preempting state laws like California’s — a prospect the tech industry would like. As we’ve previously discussed, California’s law — which aims to enhance consumer control over their data — has worried some health care observers. They believe the legislation was unclearly drafted, which might result in compliance burdens for the health care sector.

— In Congress…: Meanwhile, in the nation’s capital, FTC commissioners extensively discussed privacy requirements before the Senate Commerce Committee, our Tech colleagues John Hendel and Ashley Gold report.

Commissioners asked for more power and resources from the government to protect consumer privacy. “Our staff is literally almost killing themselves, they’re working so hard on these litigations,” said Commission chair Joe Simons.

But while the commissioners were unified in calling for federal privacy legislation, they disagreed about the critical issue in writing such a bill: whether it would preempt state law and enforcement powers. With congressional control divided, any successful bill in 2019 will need bipartisan sign-off.

Democrats would like to preserve state latitude to create tougher privacy bills. (Keep in mind that state attorneys general often enforce HIPAA under current law.) Republicans want a more uniform national standard. We’ve discussed the prospects of a national privacy bill, and its implications for health care, here.

TELEMEDICINE NOTES: Some updates to share from the world of telemedicine:

— Research: New research in JAMAsuggests that telemedicine use has grown but is still uncommon. In an analysis of more than 200,000 commercially insured patients between 2005 and 2017, researchers found that visits grew from 0.020 per 1,000 members to 6.57. And despite arguments that telemedicine is especially useful for rural patients, the majority — 83 percent of patients — lived in urban areas.

Telemedicine visits were largely for mental health and primary care, comprising 53 percent and 39 percent of total visits respectively. Researchers also found a rapid growth in primary care telemedicine visits in 2017 after commercial insurers expanded coverage for direct-to-consumer visits.

The slow uptake in rural residents echoes data from a recent USDA survey, which finds that people in rural areas are less likely than their urban counterparts to do health research or pay bills online, or to participate in remote monitoring.

A reportthat CMS delivered to Congress earlier this month found about a 50 percent growth in usage among patients enrolled in fee-for-service Medicare between 2014 and 2016. CMS’s analysis found 90,000 of the 35 million fee-for-service patients were using telehealth.

— Biz notes: Carla Kriwet, CEO of Connected Care and Health Informatics at Philips, tells Morning eHealth that CMS could further boost adoption by promoting quality measures that incorporate patient’s desires to cut travel time and costs, and communicate with clinicians wherever and whenever they need.

Philips is currently rolling out several telemedicine stations at VA facilities that can pull data from patients’ EHRs, make predictions about adverse events, and let staff remotely monitor patients. Kriwet wouldn’t comment on whether the VA’s turbulent EHR modernization project with Cerner has interfered with those installations.

More reactions — from Eric Topol, in the New York Times; and Noah Smith, in Bloomberg — on the announcement of genetically edited twins.

Reuters reports on physician burnout and the role of, yes, EHRs.

Is radiation oncology ready for alternative payments, asks Chilmark Research.