DHS ‘black hole’ complicates health care for immigrants

With help from Arthur Allen (@arthurallen202) and Mohana Ravindranath (@ravindranize)

Editor’s Note: This edition of Morning eHealth is published Mondays, Wednesdays and Fridays at 10 a.m. POLITICO Pro eHealth subscribers hold exclusive early access to the newsletter each morning at 6 a.m. Learn more about POLITICO Pro’s comprehensive policy intelligence coverage, policy tools and services at politicopro.com.

Quick Fix

— DHS “black hole” complicates health care for immigrants: Disparate, poor standards of record-keeping at the Department of Homeland Security are leading to mistreatment and even death of immigrants in custody, a review of department records and conversations with experts show.

— Data privacy hearing on tap: Senate Commerce considers dueling data privacy bills this week, with Republicans and Democrats sparring over the proper scope of regulation.

— Tele-pot?: New Jersey could push the frontiers of telehealth with medical marijuana prescriptions.

And more. But first, the jump.

eHealth tweet of the day: Shannon McNamara, MD @ShannonOMac “Fun fact: ER doctors call each other at different hospitals in the middle of the night to get info on patients that we can’t see in our electronic health records.

The patient often says ‘look up my information in the computer’ but we can’t because the computers don’t share data.”

MONDAY: Hope everyone had a nice, restful Thanksgiving holiday in which we had good times with friends and family, and were, upon reflection, grateful for the nice parts of our lives. One person’s reflection meant a distinct lack of gratefulness, your correspondent notes. Ninety-six-year-old former journalist John Richards has decided to shut down the Apostrophe Protection Society, London’s Evening Standard reports. A lack of caring about grammatical standards means “the ignorance and laziness present in modern times have won.” Discuss lax standards by email at [email protected]. Discuss standards socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

DHS’s “BLACK HOLE” ENDANGERS MIGRANTS — Patients under DHS custody are suffering due to department’s poor standards in record-keeping, a review of department records and interviews show. The problem is all the more pressing as more immigrants come under DHS custody either at the border or within the country.

A review of 22 departmentally-released detainee death reviews show several instances of poor documentation, experts say, and doctors and lawyers who assist immigrants say that they often don’t receive records from DHS.

DHS agencies have different policies, and their software doesn’t seem to consistently transmit patient information, according to immigration advocates. Physicians who work with the records say it’s almost impossible to glean clear understandings of a patient’s condition from them.

ICE has previously touted its conversion to an electronic health record system, and says its partner facilities are held to standards of good care, like documentation. CBP told us that the agency transfers information as appropriate, albeit on paper.

The problem is starting to receive legislative attention, with Rep. Lauren Underwood authoring a House-passed bill, the U.S. Border Patrol Medical Screening Standards Act, H.R. 3525 (116), which would require adoption of an EHR for medical screening at the border. But it’d be an incomplete solution (if it works), as it would address just one part of health care provided by the department.

In Congress

DATA PRIVACY HEARING ON TAP — The Senate Commerce Committee is set for a contentious hearing on Wednesday as it considers dueling data privacy bills.

A 25-page discussion draft from committee chair Roger Wicker (R-Miss.), obtained by our Tech colleague Steven Overly last week, takes a more industry-friendly approach by pre-empting state laws and barring private citizens from suing companies that mishandle data. It’s an approach that runs against Wicker’s opposite number on the Commerce panel, Maria Cantwell (D-Wash.), who has introduced her own bill

Democratic proposals have generally taken the opposite tack on each question, and insisting on preempting state laws and allowing for lawsuits might make the Wicker proposal a non-starter in the short term, as Californian legislators Nancy Pelosi and Dianne Feinstein have previously signaled their unwillingness to go along with any bill that weakens their state’s landmark privacy legislation.

For health care watchers, however, both Wicker’s and Cantwell’s proposals establish tougher regulations on “biometric” data, which might bring some rules over the vast amount of health data not covered by HIPAA.

— Also on watch: FDA commissioner nominee Stephen Hahn is due for a HELP committee vote Tuesday … Appropriations negotiators are haggling over total funding levels for the Labor-HHS-Education bill, as Democrats would like to fund departments like HHS more richly, our colleagues Caitlin Emma and Jennifer Scholtes report.

TELE-POT? — A bipartisan bill authorizing prescription of medical marijuana over the phone or online platforms was introduced in New Jersey, our colleague Sam Sutton reports. The bill is intended to help patients who have mobility or access issues.

It’s unclear if the lame-duck measure will move before the state’s legislative session ends on Jan. 14, but its passage could accelerate the growth of a burgeoning medical marijuana program.

OCR SLAPS HOSPITAL SYSTEM WITH $2.2M FINE — Sentara Hospitals, a health system in Virginia and North Carolina, has been slapped with a $2.2 million fine, HHS’s Office for Civil Rights said.

The breach was low-level, affecting 577 patients. But the system wrongly concluded the breach only affected 8 individuals, because only patient names, dates of service, and account numbers were exposed — not diagnoses and medical information. OCR disagreed with that analysis and told Sentara so — only to be rebuffed. Hence the fine.

“Although this breach looks ‘small’ in comparison, keep in mind that the breach is often what triggers the investigation,” tweeted Deven McGraw, a former OCR official who’s now at startup Ciitizen. “[B]ut then OCR find many other violations, all of which contribute to the potential penalty amount. And failing to do what OCR asks? Bad idea.”

RESEARCH CORNER — Some research worth your time in the latest journals:

— Oncology genomics review: A review of the current science in the New England Journal of Medicine notes that data storage and analysis will be necessary no matter what the type of cancer care is being contemplated, whether it’s monitoring blood for signs of a tumor or tailoring pharmaceutical care to a patient’s specific type of cancer. Those tools will make sure doctors are drawing from a wide variety of information before making a decision.

— Video diagnosis of atrial fibrillation?: A group of Hong Kong researchers have a proof-of-concept study demonstrating that patients can be passively diagnosed with atrial fibrillation by videos. In a JAMA Cardiology study, the researchers used a camera in a doctor’s office to analyze video of 44 patients, and were able to diagnose patients’ atrial fibrillation with sensitivity and specificity over 84 percent each. That percentage is low if you’d actually like to deploy the technology, but it does demonstrate the potential of using video as a passive diagnosis tool.

Such a technology, if functional at high volumes, would allow health systems to focus their attentions more precisely without the need for serial one-on-one consultations — a boost to productivity.

Of course, such a study raises ethical qualms, notes an accompanying editorial. “Cameras in public areas, waiting rooms, and even hospital wards may have the potential to identify heart rate and rhythm abnormalities, but what are the implications for privacy and confidentiality?” the editorial asks. If the data falls into the wrong hands, it could be a big problem.

What We're Reading

WilmerHale’s Kirk Nahra previews 2020 in health privacy.

A crackdown on opioids — enabled by prescription drug monitoring programs — is hurting Arkansas patients in pain, reports the Arkansas Democrat-Gazette.

Pro-vaccine parents are taking on anti-vaxxers on Facebook, Vice says.