New twist in Shulkinology

SHULKINOLOGY UPDATE: The Shulkin saga didn’t subside over the weekend, as the now-former VA secretary insisted that he was fired, while the White House is saying he quit. The distinction is more than a prideful one, and it might have an impact on the VA’s long-running EHR contract process. As our colleague Andrew Restuccia reports, an obscure bill called the Vacancies Act gives the president pretty expansive powers to fill, well, vacancies in a federal agency with an acting replacement. But those powers only clearly apply when the void is created by resignation; it’s unclear whether any acting official can be legally appointed in this fashion when a spot opened up because of a firing.

And here’s where the EHR deal comes in. Let’s say acting VA secretary Robert Wilkie decides to sign the Cerner contract. It’s theoretically possible that a competitor could sue the VA and argue it wasn’t validly signed, because Wilkie shouldn’t be the acting VA secretary. And, for what it’s worth, there’s already litigation arguing the no-bid EHR award wasn’t proper in the first place. So, putting two and two together, we might see some novel legal territory explored.

Still, the Wall Street analysts we spoke to last week were betting that Wilkie would delay an EHR contract signing and leave the decision to a Senate-confirmed secretary. That would sidestep the legal parlor games.

PREVIEW OF THE WEEK AHEAD: These days it’s hard to reliably predict what’s going to happen any given week. Still, there are some events you should be looking out for:

— NIH data science comments: The National Institutes of Health is considering a new data science strategy, with comments due today. The 26-page draft plan argues that the metastatic growth in data — combined with increasing demands on scientists’ time to manage and clean that information — requires new computing strategies to efficiently practice science. Cloud computing, supercomputing, and other new techniques can help, but the document is concerned with how to implement those ideas — hence the request for comments.

Some comments are already trickling in. The American Medical Informatics Association in its letter to be submitted today argues that the Institutes could go further in promoting data-sharing: by making a grantee’s plan to share data and algorithms part of the scoring for proposals, to take one example.

Other commenters are a bit harsher. Bill Hersh, a medical informaticist at Oregon Health and Science University, in a blog post says more research should be devoted to the meta-issues surrounding data science: standards for categorizing data, and ways to implement the products of data analysis into clinical workflows, to take two examples.

More scathing is Jason Williams, of Cold Spring Harbor Laboratory in New York. Williams believes the plan is guided by bad measurement, writing that, “the majority of metrics proposed are simply ‘counts’ of the number of activities created or performed, without any meaningful and/or independent evaluation of their benefit.”

— MedPac: Congress’s Medicare advisory committee is meeting April 5-6, and some data topics are on the agenda. The committee will consider Medicare Advantage encounter data and its potential uses. The encounter data, a long-held desiderata of policy wonks and dataheads, was due to be released last year during a conference. That release was canceled, leading to outcry among the academic community. We’ll see whether MedPac’s agitating leads to movement on this issue.

The commission is also due to discuss outcome measures for post-acute care, hospital quality incentive payment adjusts, and Accountable Care Organizations, among other subjects.

eHealth tweet of the day: Farzad Mostashari @Farzad_MD

Can I be annoyingly two-armed?

1) @Apple Health is building on a decade of painstaking policy and standards work.

2) without Apple’s heft and attention to UI, this would not reach millions.

Kudos all around

@amalec @rickybloomfield @mickytripathi1 @aneeshchopra @carinalliance

MONDAY: We hope you enjoyed a nice Easter, or Passover, or spring weekend as the case might be. Your correspondent is, as usual, amazed by the influx of tourists gawking at the trees in bloom. (Which are, as usual, pretty in pink.) Were you enjoying the relatively nice weather (while it lasted)? Share with [email protected]. Talk spring on social media by tapping into your cellphones (fast before your fingers freeze, given today’s unspringlike forecast) at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

YOU WILL NEVER BREAK THE BLOCKCHAIN: Five health care groups are testing out a blockchain ledger for sharing up-to-date provider information with each other, they announced Monday. Multiplan, Quest Diagnostics, UnitedHealthcare, UnitedHealth Group’s Optum, and Humana (reportedly in early stage talks to be acquired by WalMart) are testing out the viability of blockchain, a decentralized ledgering system, for sharing the standard provider data that flows into patient claims, company executives tell Morning eHealth.
The pilot isn’t just assessing the usefulness of the system, but also estimate the costs associated with implementing a Blockchain system, Optum senior engineer Mike Jacobs tells us. The five groups are test-driving Blockchain in one specific market -- executives declined to identify which market — but will consider expanding elsewhere after the initial pilot, they say.

NOTES FROM THE JOURNALS: A quick heads-up on relevant journal articles:

— What do EHRs mean for cardiology care? Not much, argues a new study in the Journal of the American Heart Association.

The study used a registry of heart failure patients and linked it to the American Hospital Association’s survey on EHR and technology use. Using that information , they compared what happened to heart failure patients admitted to hospitals with advanced EHR capabilities versus those with less advanced (or no EHR at all) in 2008. They found no association between EHR use and improvement in quality metrics or event rates, like death and readmission. However, the results predate the HITEHCH program, which leads the authors to argue that optimization — rather than mere possession — of the EHR is the determining factor in quality improvement.

— The Lancet on data: The Lancet has a pair of pieces on data in its most recent issue. In a brief editorial on cybersecurity, the authors note the somewhat troubled recent history of hospitals confronting digital threats. That’s due to the oftentimes lax reviews and standards of devices and the organizations that purchase them.

“Soon, devices might be assessed as much on their cybersecurity as on performance in [randomized] trials,” the editorial concludes. “Patient wellbeing and protection depend on both.”

In a more international focus, another article considers the health sector’s readiness for Europe’s General Data Protection Regulation.

WHAT WE’RE CLICKING ON:

—In The New York Times, a doctor bemoans the inaccessibility of advance end-of-life directives in the EHR.

—In The Military Times, a pair of siblings can’t enlist in the military — because of mental health counseling they sought years ago while their father was deployed, that was documented in their DOD records.

—How did EHR designers get a hold of medicine, one doctor asks?