Trump administration talks tech and transparency

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

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It’s State of the Union day. We’re expecting to President Donald Trump to talk about ending HIV, and perhaps drug pricing. If you’re looking to join the administration, OCR is hiring a " Regional Manager for Investigations.” In the private sector, Cerner is slated to announce earnings. Until then, here’s what we’re tracking:

—HHS Secretary Alex Azar said health IT could improve price transparency in remarks to the Academy Health Conference Monday.

—The AMA and a group of researchers are turning up the heat on Congress to help end gag clauses for EHR products.

—Massachusetts lawmakers appear to be taking another stab at telehealth parity.

eHealth Tweet of the day: Kirk J. Nahra (work) @KirkJNahrawork two things to watch for when a company endorses national #privacy legislation: (1) do they support a national law (first, and obviously), but more important (2) what do they want a national law to say. #2 covers a range from essentially nothing to an aggressive federal law.

It’s TUESDAY at Morning eHealth where your author, like much of Twitter, was stunned by this New Yorker profile of Daniel Mallory. She especially enjoyed the Agatha Christie tie-in that led to “You’re So Vain, You Probably Think This Poirot’s About You.” Thoughts and tips go to [email protected]. Tweet the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

TRUMP ADMINISTRATION TALKS TECH AND TRANSPARENCY: In the lead-up to Trump’s public address tonight, HHS Secretary Alex Azar has been on the speaking circuit, hitting Academy Health’s National Health Policy Conference, a SAMHSA conference, and a stop planned today at the Rural Health Policy Institute. At Academy Health, Azar pointed to health IT programs he said would make “fair, accurate, and transparent prices.”

He mentioned apps to help seniors understand their Medicare data through the Blue Button 2.0 program, and the Promoting Interoperability program, aimed at creating a “patient-centered health IT system.” Trump is committed to transparency, Azar asserted, in drug prices and in “ending surprise bills, empowering patients to shop for healthcare services, and holding providers accountable for outcomes.”

...Speaking of drug pricing, one expert says the Trump administration’s rebate overhaul proposal could make room for consumer companies like Amazon in the pharmaceutical market. Amazon acquired online pharmacy PillPack back in June, and some have speculated the mysterious Amazon-Berkshire Hathaway-JPMorgan Chase venture might attempt to use its clout to negotiate down drug prices for its combined 1 million employees.

According to David Friend, managing director at the BDO Center for Healthcare Excellence & Innovation, the current rebate system has “protected the pharmaceutical industry for a certain group of companies” because drug manufacturers pay rebates to pharmacy benefit managers whose members get preferred access. But if consumers didn’t have PBM rebates, they could “make Amazon—or some other new entrant—their home pharmacy,” Friend said.

...In other Amazon news, that mysterious health venture has a new chief technology officer. Serkan Kutan, who left Zocdoc a month ago, announced in a LinkedIn post that he’s now working for “the most promising attempt to improve health care in the U.S,” which requires “the best technology team in health care.” (Zocdoc is dealing with its own financial issues, CNBC has reported that a pricing change could make the service prohibitively expensive for some doctors.)

EHR SAFETY CAMPAIGN PRESSURES CONGRESS TO GET RID OF GAG CLAUSES: EHR safety researchers and the AMA are running a campaign to eliminate that and other hurdles to sharing information on EHR risks and usability challenges, Arthur reports. The campaign includes a website called EHRSeeWhatWeMean.org, which demonstrates some potentially dangerous usability problems.

The screens shown on the site were captured during work on an EHR safety study, published in July, that examined work stations at two hospital systems employing Cerner and two that used Epic. The Cerner EHR screens on the website are video snippets, but the Epic monitors are simulated because Epic refused to allow shots of its screens to be published, said Raj Ratwani, director of MedStar Health National Center for Human Factors in Healthcare, adding he was disappointed because "[p]atient safety should be the top priority for every single party, including vendors.”

Epic President Carl Dvorak denied his company has gag clauses. Epic fosters transparency and communication “related to any potential safety issues, no matter how unlikely,” he said. “We don’t believe that unregulated public posting of our IP is necessary or beneficial in order to maintain safety. Posting accurate simulations shares the essential potential issues while allowing us to maintain our competitive advantages in design.”

Few of the many EHR safety studies published in the last decade contain screen shots because gag clauses in vendor contracts with health care companies often prohibit them, Ratwani noted. The contracts also usually include “hold harmless” clauses that diminish the possibility of holding EHR vendors accountable for their role in medical errors.

The letter campaign seeks to press Congress to encourage better measures of EHR usability and safety and a database to report and view them, like the systems the FDA uses to monitor medical device safety, said Ratwani. Pros can read the rest of Arthur’s story here.

... The campaign has support from other health IT groups, including the American Medical Informatics Association. That group has called for a public-private partnership for collecting and disseminating information on safely using health IT, it said in a statement.

...Slack could be entering the health IT game too, CNBC’s Chrissy Farr reports. The company known for its team communication platform updated its security page to reflect its HIPAA compliance, though skeptics like Genevieve Morris, formerly of ONC, wondered on Twitter if its product would work in a health setting. “What’s interesting here is that the assumption is that healthcare runs the same as other businesses like software dev, consulting, etc.,” she mused. “Do we know if the same types of communications and channel approaches would work in a provider’s office like they would in other offices?”

MASSACHUSETTS PUSH FOR TELEHEALTH PARITY: State lawmakers are reintroducing bills to put reimbursement for telehealth services on par with in-person appointments, renewing an effort that died in the previous session when the state’s House and Senate couldn’t agree on a final version. HD3057 states that certain public and commercial payers—including health maintenance organizations, preferred provider organizations and state insurance groups—can’t decline to cover services simply because they’re provided via telemedicine. Another provision allows Medicaid managed care organizations to cover telemedicine services, but doesn’t require it. HD761 outlines similar provisions. Lawmakers appear to be “revitalizing” their push for coverage parity, Foley & Lardner’s Kyle Faget tells Morning eHealth; if passed, such measures could “open the gateway for telemedicine in Massachusetts.” Unlike more rural states that have already made it easier for remote patients to get coverage for virtual treatment, Massachusetts is “constantly criticized by everybody for failing to be a pioneer in the telemedicine landscape.”

Health information exchanges can improve patient outcomes in addition to making the transfer of health data easier, new research published in Health Affairs suggests. In an analysis of state-level data from Florida, researchers found that participation in an HIE was linked to a decreased probability of unplanned 30-day re-admissions for myocardial infarctions. There were fewer readmissions to hospitals other than the one the patient initially enrolled in, which “implies an improvement in continuity of care.”

—Wired reports on Google’s new apps for deaf consumers

—Jay Deady’s opinion in Stat on hospital price transparency

—Tom Vanderbilt writes in The New Yorker about “reverse innovation,” or bringing solutions from low-resource settings into wealthier ones