VA dustups continue

With help from Arthur Allen (@arthurallen202)

VA DUSTUPS CONTINUE: The VA still hasn’t sailed out of the rough stuff. On Wednesday, leading House Democrats Tim Walz, ranking member of the House Veterans Affairs Committee, and Debbie Wasserman Schultz, a member of Appropriations’ Veterans Affairs subcommittee, escalated a conflict over the department’s budget, releasing a statement criticizing their Republican counterparts’ efforts to keep spending on veterans within existing budget caps.

“Budgets are more than just fiscal documents, they are a reflection of our values,” Walz said, as an opener. Things got more heated from there.

The sparring has become bicameral, as, in recent days, Republican leaders have been assailing Senate Appropriations Chairman Richard Shelby for his decision to side with Democrats in the budget dispute. OMB chief Mick Mulvaney and VA acting secretary Peter O’Rourke sent a letter criticizing the idea. If the conflict isn’t resolved, our budget colleagues Sarah Ferris and Jennifer Scholtes say, it could lead to a stopgap funding bill.

Later Wednesday, the Washington Post released an article revealing that political appointees at the Department of Veterans Affairs have been purging or reassigning staff “perceived to be disloyal to President Trump.” The department has, of course, been wracked by conflict this year, with political appointees and David Shulkin, the ousted secretary, each trying to purge the other earlier this year. the other. It seems the appointees have won this battle.

Looming over everything, as we know, is the impending Cerner installation.

— Speaking of…: The Interagency Program Office (or IPO) might get revitalized by the House VA EHR subcommittee, our colleague Arthur Allen reports today. The office, originally created in the 2008 Defense Authorization Act, was originally intended coordinate the VA and Department of Defense’s joint EHR effort. Ten years later, both departments are trying to implement an EHR in coordinated fashion – but this time around, it is, of course, a private sector EHR. Still, conceptually, it’s a powerful tool.

The subcommittee is slated to hold three hearings in the remainder of the year. Pros can get the rest here.

— Oh and one more thing…: Meanwhile, in more clinically-focused news, the VA is announcing the extension of a public-private partnership with IBM, the company is announcing today. The partnership serves to deploy artificial intelligence to cancer data to help treat vets. Under the terms of the partnership, VA oncologists can use IBM’s Watson for Genomics through at least June 2019. The tools can help analyze genomic data to tailor treatments to patients’ tumor.

AHRQ “LOOKING FOR PARTNERS” TO MAINTAIN GUIDELINE CLEARINGHOUSE: At a meeting Wednesday of the Agency for Healthcare Research and Quality’s advisory committee, acting deputy director Francis Chesley said AHRQ was “engaging many stakeholders” and “identifying partnerships” to sustain Guidelines.gov, which closed down Monday after the agency ran out of money for the $2.1 million annual contract with ECRI to support it. The “data won’t be lost,” Chesley said, acknowledging the anxiety that the shuttering of the site had caused in the medical and research communities. “But it has gone dark meanwhile.”

The ECRI Institute said Monday that it would restore a version of the clearinghouse on its own website beginning in the fall, charging some kind of subscription or fees to fund it. Asked about Chesley’s comment, institute spokeswoman Laurie Menyo said: “We have been in touch with AHRQ, but were not given any details about their plans. In the interest of providing trustworthy guidelines to the healthcare community, we are continuing to build our own website.”

Gopal Khanna, the beleaguered agency’s chief, gave the advisory committee a rather dire warning that AHRQ had to “reinvent our enterprise. Doing things the way we have in past is not an option. Tinkering around the edges won’t work either.” He didn’t specify; the White House, which proposed doing away with AHRQ in its 2019 budget request now wishes to move its functions to NIH.

“We need an elevator speech that makes clear what AHRQ does that’s different,” said committee member Lucy Savitz, a Kaiser Permanente health researcher. “My phone has been blowing up about the guidance clearinghouse. Where were these people all these years?”

eHealth tweet of the day: Rob Tweed @rtweed “If it all turns into a disaster, expect Trump to say that when he said ‘Cerner should replace VistA’ that it was a mistake in the heat of the moment and he meant “shouldn’t” #healthit”

THURSDAY: Your correspondent simply can’t stop watching this video of a New York man setting a Guinness world record for chopping watermelons on his stomach — 26 in 60 seconds, wielding a katana. The video contains several fantastic details: a touching devotion to safety, as evidenced by his black performance gloves, a surprising detail given his use of, well, a blade to slice open watermelons on his belly; and second, the charming admission that he literally made up the record just to claim one. It’s really all rather beautiful. Suggest world records for your correspondent at [email protected]. Discuss records socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro, @Morning_eHealth.

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FDA UNVEILS EHRs-IN-CLINICAL-TRIALS GUIDANCE: Researchers hoping to use EHRs to conduct FDA-regulated clinical trials got some final guidance on the subject Wednesday.

The document, part of the agency’s 21st Century Cures responsibilities, offers suggestions for investigators for using clinical EHRs rather than specialized research software. The tips include ideas like these: ONC certification (when applicable) is good, and so is interoperability. Data reliability is also important, and if (for example) your EHR might ruin the blinding on your trial, consider going without the record.

Research groups were moderately pleased. “This guidance is an important step towards realizing our unprecedented opportunity to use EHRs for clinical research,” said Doug Fridsma, CEO of the American Medical Informatics Association. The group is happy that the guidance improved on its earlier draft, as it feels the first version oversimplified the process of connecting EHRs with research software.

Heather Pierce, the Association of American Medical Colleges’ senior director for science policy, told us that the organization is “pretty pleased with how it turned out.” While the agency is encouraging interoperability, and recognizing its challenges, it’s not getting prescriptive, she noted. Pierce also said the final guidance added a section on trials that involved multiple types of EHR software and the challenges with transferring and integrating data in those situations, which is helpful.

“[There are] far more questions than answers in the how EHR data will be used and can be used effectively for research,” she said. “This is a step in the right direction.”

BOEHLER GETS PROMOTION: CMMI director Adam Boehler is getting a promotion at HHS, after only a few months on the job. While he’ll still be serving at the CMS innovation center, Secretary Alex Azar is also naming Boehler the senior advisor for value-based transformation and innovation. That makes him the top staffer on value-based pay.

The move garnered praise from industry. Federation of American Hospitals CEO Chip Kahn praised Boehler’s “bold vision for the future of the nation’s health care system,” and hailed him as an “actual innovator in health care.”

Farzad Mostashari called the appointment a “very smart move” on Twitter, saying it would “provide alignment across agencies without adding another cook to the kitchen.”

DEFAULT SETTINGS CAN REUDCE OPIOID PRESCRIPTIONS: Changing the default settings in Yale’s EHR system turned out to be a simple way to reduce opioid prescriptions, researchers report in a new study in JAMA Surgery published online Wednesday.

The researchers lowered the default number of opioid pills prescribed for pain after procedures from 30 to 12, based on previous research that 10 to 15 is needed after most operations. Critically, while prescribers could modify the amount if they chose, the number of pills dropped considerably. There was no statistically significant increase in the number of refill requests.

TOUTING E&M OVERHAUL: CMS and ONC got together Wednesday to tout their proposed overhaul of evaluation and management codes. The government wants to minimize the amount of documentation associated with the codes, which will mean providers have to do less copy and pasting and the like to bill for more complex services. ONC director Don Rucker predicted that doctors will notice the change. They’re “going to save time in every note,” he said. That, in turn, might allow for better design of EHRs and more efficient data-crunching, he suggested.

PRAISE FOR ELECTRONIC VISIT VERIFICATION BILL: The Senate’s passage of H.R. 6042 (115) Tuesday night has earned some kudos. The bill, which would delay the implementation of electronic visit verification requirements for a year, has now passed both chambers and is on its way to the President. The requirements pertain to Medicaid-funded services, and would make them use electronic means to verify whether, where and when recipients got their services.

But the timeframe of January 2019 was too tight, the American Network of Community Options and Resources said. The network praised the bipartisan roster of legislators — including Sens. Lisa Murkowski and Chuck Schumer in the upper chamber, and Greg Walden and Frank Pallone in the lower as making the difference.

WHAT WE’RE CLICKING ON:

—The Atlantic covers what’ll come to pass in a world without Roe v. Wade: women relying on online pharmacies for their abortions.

—Bloomberg profiles Hims, the telemedicine startup courting men with generic Viagra and hair-loss drugs.

—The Army’s website covers new on-the-field telemedicine sensors.