Survey: 1 in 4 patients used live telemedicine this year
With help from Arthur Allen (@arthurallen202) , Darius Tahir (@dariustahir) and Joanne Kenen (@JoanneKenen)
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
We’ll see lawmakers and lobbyists discussing health data privacy and patient identifiers this week; advocates have been urging Congress to remove the ban on using federal funds for such identifiers from an HHS spending deal. And privacy groups are still weighing in on the proper protection for substance use data. Here’s what else we’ve got:
— One in four patients used live telemedicine this year: That’s just one of many tidbits from Rock Health’s and the Stanford Center for Digital Health’s annual health technology survey, out today.
— Social determinants rundown: An effort to use a subset of ICD-10 codes for housing, food security and other social determinants of health data garnered some push back. Further south, North Carolina is expanding an IT system connecting providers to social services.
— New Verily, VA partnership: Alphabet’s life sciences property Verily will test and deploy new health tools in California and New England.
eHealth Tweet of the day: Ricky Boooo! Mfield @rickybloomfield #HLTH2019 conference ProTip! Last year they put RFID tracking tags in all of the badges. If you want some semblance of privacy, be sure to remove it. As a bonus, color in a few squares of the badge QR code so it won’t scan correctly!
It’s MONDAY at Morning eHealth. What’s on tap this week? Tips go to [email protected]. Reach the rest of the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.
Driving the Day
PATIENTS’ WAVERING DESIRE TO SHARE DATA WITH DOCTORS — Patients’ willingness to share their health data with doctors has declined over time, though it’s inching back up, according to the Rock Health/Stanford survey of about 4,000 adults.
In 2017 about 86 percent of respondents said they were willing to share personal health data with their doctors; that slipped to 72 percent in 2018, and is slightly up to 73 percent this year. Patients are still significantly more likely to share data with doctors than with tech companies: Just about 10 percent of respondents reported willingness to send personal health information to tech companies in 2017, compared to 11 percent in 2018, and 10 percent in 2019.
Willingness to share data with insurers saw a similar decline; 56 percent of respondents said they were comfortable sending personal health information to payers in 2017, compared to 49 percent and 52 percent in 2018 and 2019, respectively.
... But the relationship between patients, their providers and technology companies appears to be changing. Respondents who had downloaded a health app were four times less likely than those who didn’t use health apps to share data with their providers, hinting at a a shift “away from traditional care,” authors posited. Yet those who downloaded health apps were twice as willing to share data with tech companies as those who didn’t have the apps, according to the survey.
Among other findings: One in four patients had had a live telemedicine consultation in the past 12 months, and one in three owned a wearable device, the survey found. More than four in ten said they use digital tools to track some aspect of their health.
... Speaking of telemedicine, about 29 percent of Medicare Advantage beneficiaries have access to telemonitoring services, according to a recent Kaiser Family Foundation analysis.
A HIGH TECH PLATFORM FOR SOCIAL DETERMINANTS — Our colleague Joanne Kenen did a deep dive into health care transformation in North Carolina, looking not only at payment reform but the state’s very thoughtful approach to when to spend a health care dollar on social determinants of health, and when to catalyze another social service or community group. Playing a crucial part is a new statewide electronic platform called NCCARE360, which connects numerous agencies statewide and provides a transparency and accountability to ensure follow through. People in or out of the health care system can make referrals; if one agency can’t meet the needs, the request rolls on to one that can.
“The burden now falls on the agency to reach out to the individual,” said Laura Marx, president and CEO of United Way of North Carolina, which has played a lead role in the public-private partnership. “We’re not putting the onus on the person who is in crisis.”
... In other social determinants news, an effort by the eHealth Initiative & Foundation to assign the “Z” category of ICD-10 clinical data codes to data about housing, transportation and other factors drew criticism from Signify Health, which sells health risk and care management technology.
“Z” codes are “notoriously general, only diagnostic and clinically oriented,” said Jamo Rubin, president at Signify Community, said in a release. Social determinants of health data don’t represent a clinical problem, but instead a social problem, he continued. "[W]e risk medicalizing SDOH if we look at it solely through a health care lens.”
... Some researchers have argued that clinicians should still enter information about patients’ personal life events into EHRs. In a recent JAMA Viewpoint, Myrna Weissman, Jyotishman Pathak, and Ardesheer Talati proposed that clinicians give patients a simple questionnaire querying information such as psychiatric family history, recent personal events such as deaths or or disputes, and adverse childhood events. Those factors could help clinicians better understand patients’ psychiatric needs and potentially predict suicide, they wrote. "[S]uch personal life events remain an underrecognized dimension in EHRs,” authors argued.
Data aside, how do we pay for these programs? That’s what the National Quality Forum hopes to illuminate with its recent call to action on social determinants of health payment and quality. Following an August summit convening several groups including Aetna, Humana, Lyft and the American Hospital Association, NQF has published recommendations to help organizations increase the use of social services programs, including that they set aside funding for testing the effectiveness of community-based social determinants of health programs.
VA, ATRIUS AND VERILY COLLAB ON POP HEALTH — The life sciences division of Google parent company Alphabet is working with the Veterans Administration Palo Alto Healthcare System and New England’s largest independent medical group on various population health analyses, the groups announced last week.
At the VA Palo Alto system, Verily plans to focus on understanding total knee arthroplasty, acute myocardial infarction, and alcohol withdrawal; at Atrius, they’ll be predicting hospitalization to keep heart failure patients out of the emergency department.
... In other VA news, the Pentagon and VA Industry interoperability roundtable previously scheduled for Nov. 5 has been postponed, and officials are targeting the end of January or early February to reschedule, according to the Defense Health Agency.
STERILIZATION PLANT CLOSURES COULD DISRUPT MEDICAL DEVICES: FDA — Closing medical device sterilization plants over concerns about leaks of a carcinogenic gas could threaten the supply of products used in critical medical procedures, the FDA warned last week.
Concern about leaks of ethylene oxide gas led to the closure of two Sterigenics plants in Georgia and Illinois this year, and a Becton Dickinson plant in Georgia may also close, eHealth’s Arthur Allen reports. The gas, which is used to sterilize 20 billion devices a year in the United States, can reach small crevices in devices used for surgeries.
... Use of the gas “is critical to our health care system and to the continued availability of safe, effective and high-quality medical devices,” acting FDA Commissioner Ned Sharpless said in a release. “There are no readily available processes or facilities that can serve as viable alternatives.”
The agency is working with device manufacturers and health care systems to come up with contingency plans, according to Sharpless. FDA may also seek out a foreign company that uses the process to address the shortage, and plans to hold a Nov. 6-7 hearing on new sterilization options.
CHECKING UP ON 42 CFR PART 2 — In a letter last week to SAMHSA head Elinore McCance-Katz, The Partnership to Amend 42 CFR Part 2 pushed the agency to clarify parts of a recent proposed rule on the confidentiality of substance use disorder data.
... The Partnership, which represents patients, clinicians, hospitals, and EHR companies among others, has argued that substance use data should be aligned with other HIPAA-protected data so that clinicians have a complete picture of patients’ health history.
A part of federal code known as 42 CFR Part 2 requires that patient data gathered in rehabilitation and substance use treatment programs be kept separate from other health data, potentially to to prevent discrimination. SAMHSA’s proposal aims to reduce confusion about how these data sets are protected; among provisions are that substance use data gathered by a clinicians outside rehabilitation programs is not subject to that separation.
The Partnership posed several questions about how this and other provisions would be implemented, as well as about the “technical feasibility,” since “electronic health records currently are not capable of easily segregating sensitive data from other patient data.”
What We're Reading
— In Stat, Gary Marcus and Max Little advocate for caution when infusing health care with artificial intelligence.
— David Nash suggests in MedPageToday that clinicians should review patients’ electronic health records alongside them.
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