Omnibus: We have a deal

OMNIBUS — WE HAVE A DEAL: In a pleasant snowy day in Washington, Congressional leaders reached a deal to keep the government running for the rest of the year with a trillion-dollar-plus spending package. The bill ( H.R. 1625 (115)) keeps the Office of the National Coordinator’s and Office for Civil Rights’s funding for the remainder of 2018 flat relative to 2017. Other health IT priorities enjoyed raises. The Department of Veterans affairs also got $782 million for its Cerner installation, though it requires the secretary to submit quarterly reports on the programs progress. Shulkin has asked for $1.2 billion in Cerner funding for fiscal year 2019.

To get down to the nitty-gritty: NIH overall receives a $3 billion boost, with $290 million going to the Institutes’ precision medicine work. (That’s a $60 million increase from 2017.) Meanwhile, telemedicine won much more funding, with broadband expansion subsidized to the tune of $600 million, and as much as $82 million going to three grant programs for the modality.

Broadly, funding to combat the opioid crisis gets $4 billion. Some of that funding will be devoted to prescription drug monitoring programs; CDC is directed to make PDMPs more interconnected with each other, and integrated with EHRs. (It should work with ONC on that latter task.)

The Agency for Healthcare Research and Quality escapes the chopping block, and its funding stays flat at $334 million.

Whether this constitutes a win or a loss for the health IT sector is up for debate. Flat budgets for ONC and OCR is higher than the Trump administration’s budget request for 2018. The budget envisioned cuts of $22 million and $6 million respectively. Trump’s 2019 budget will try for another bite at the apple, once again asking for cuts of $22 million and $8 million, respectively.

But health IT advocates, naturally, feel that ONC and OCR should get raises. Ben Moscovitch, of Pew Charitable Trusts, pointed our attention to a December 2017 letter written to Congressional appropriations leaders. The letter argues that ONC’s got to have sufficient cash to fulfill its 21st Century Cures duties. (Pew Charitable Trusts has also argued, in the past, for federal funding devoted to health IT safety, though now it’s going forward with more private-sector-focused plans.)

Meanwhile, Lucia Savage, formerly the chief privacy officer at ONC, wondered, “Gotta ask how is @HHSOCR supposed to give right of access teeth with no budget increase?”

AI FOCUS: Meanwhile, the implications of further tech development in artificial intelligence captured our attention:

— New AI trade group: The American Telemedicine Association’s former CEO, Jonathan Linkous, has co-founded a new trade group dedicated to artificial intelligence and automation in health care.
Linkous left the ATA last year after 24 years ; he’s now leading a new trade group, called the Partnership for Artificial Intelligence and Automation in Healthcare. Members will include health systems, industry, payers, regulators and individual professionals, and its goal is to more widely apply AI and automation to health care. “With spiraling costs, increasing need, decreasing resources, and rapidly advancing technologies, healthcare desperately needs to catch up,” according to Linkous. More for Pros here.

— New study shows some promise for atrial fibrillation-sensing gadgets: Small gadgets, using apps trained by artificial intelligence, have made at least preliminary progress in passively sensing atrial fibrillation, according to a new study in JAMA Cardiology. This particular effort – teamwork among the University of California, San Francisco, and startup Cardiogram – had some hiccups, as the app uploaded to an Apple Watch was not as successful at detecting arrhythmias when used on a real-world population (as compared to a group undergoing cardioversion at the doctor’s office). As a consequence, UCSF’s Greg Marcus, a co-author, acknowledged that “we are not yet ready to roll out broad screening for atrial fibrillation using these tools quite yet.”

Yet the UCSF/Cardiogram effort isn’t the only attempt in this field. We’ve seen medical device manufacturers AliveCor build its own widgets to detect atrial fibrillation, and Apple itself is trying a clinical study. If the technology matures, the health care system will have to confront questions of implementation and cost-effectiveness. Pros can get the rest here; we also recommend this Twitter discussion between a Cardiogram exec and a few skeptical cardiologists for a detailed dive into the study.

— National security artificial intelligence commission?: Rep. Elise Stefanik (R-N.Y.) is introducing a bill that would create a commission to consider the national and economic security implications of artificial intelligence, our Cybersecurity colleagues note.

eHealth tweet of the day: Jeff Smith @jefferyrlsmith Simultaneously streaming @AllofUsResearch and @ONC_HealthIT #HITAC meetings...looking for a way to drop a 4-on-the-floor beat to merge the two...suggestions?

THURSDAY: As your correspondent writes this entry, he sees … virtually all the snow has melted away. Not much of a snow day, eh? Tell us about your winter-in-spring activities at [email protected]. Discuss wintry mix socially at @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.

HITAC ON TEFCA: ONC’s advisory board is urging the agency to improve parts of the Trusted Exchange Framework draft. The Health Information Technology Advisory Committee voted Wednesday to accept a set of 27 recommendations from an internal task force about the Trusted Exchange Framework, including that ONC should clearly define its policy goals and better explain how the framework could further national goals, such as improving patients’ access to data. The task force also recommended that ONC cut down on the framework’s duplicative requirements — and look to NIST for existing guidance on topics such as encryption algorithms. More for Pros here.

The task force leader, Arien Malec, tweeted out a storm of reflections on the recommendations, stating that his group’s work “beats the landspeed record for most high quality recommendations relative to time in deliberation.” Malec concluded that the “the real … recommendation letter was the journey and the friends we made along the way.”

TRUMP ADMINISTRATION OFFICIALLY NAMES REDFIELD FOR CDC: Robert Redfield, a prominent HIV/AIDS researcher at the University of Maryland, is the official appointee for the CDC, the Trump administration announced Wednesday. While questions have been asked about Redfield’s views on HIV/AIDS (he supported mandatory testing and naming of patients early in the epidemic) and his potential research misconduct, the administration moved forward anyway. Our Health Care colleague Brianna Ehley mainly heard praise from Redfield’s peers in the scientific community, and Sen. Lamar Alexander, the HELP Committee chair, was also pleased by the appointment. Alexander said in a statement that Redfield had a “strong background” to lead the agency. Redfield earned bipartisan praise; Rep. Elijah Cummings, a fellow Marylander, also gave his imprimatur.

At the CDC, Redfield can influence several areas of eHealth policy: the agency disseminates information and grants on prescription drug monitoring programs, to take one example.

TECHNOLOGY HOLDING UP NURSING HOME CARE: Telemedicine is merely in its infancy and too early to know how it could help nursing home patients, an executive of the nursing home trade group said at a POLITICO Live event Wednesday. “Telemedicine is just all over the map for what it means,” said David Gifford, senior vice present for quality and regulatory affairs at the American Health Care Association. But it has a lot of promise and showing some signs of success.

Still, the recent passage of the CHRONIC Care Act will help since it makes it easier for Medicare Advantage plans to offer telemedicine, panelists Wednesday said, allowing health insurers to experiment with the technology.

— An old bugbear: The lack of interoperability is a “big problem” for nursing homes, said Ruth Katz, head of public policy at LeadingAge. Nursing homes lose track of patients when they go to the hospital and have no idea how they were treated when they return.

Tim Peck, co-founder and chief executive of Call9, which provides telemedicine visits in nursing homes, said congressional offices are working on a bill intended to help nursing homes use telemedicine that should be introduced in the next few weeks.

View the full event here if you missed it.

HACKING UPDATE: How are our health care organizations doing on the hacking front? Over half of HIPAA organizations suffered a hack over the past 12 months but it’s a mixed bag in terms of progress relative to fiscal year 2016, our graphics team at DataPoint show.

— Also: Geneva, N.Y.-based Finger Lakes Health was the victim of a ransomware attack earlier this week, Health Data Management reports.

WHAT WE’RE CLICKING ON:

How algorithms in Arkansas’s Medicaid program reduced access to care, in The Verge.

The Chinese health care system is going full speed ahead in implementing artificial intelligence to relieve doctors’ work burden.

How Mayo Clinic and Epic are trying to streamline patient care.

A JAMA commentary argues precision medicine can reduce cancer overtreatment.