OMB holds health IT’s future

With help from Darius Tahir and Mohana Ravindranath

BIG HEALTH IT RULES ARE READY TO RUMBA: A proposed CMS rule on health IT interoperability has been submitted for OMB review, following ONC’s long-awaited rule defining acceptable information blocking, which was sent over to the White House earlier last week. Once these two rules emanating from the December 2016 21st Century Cures Act emerge — it could be a matter of days, weeks or at most a couple months — we’ll have the big picture of the Trump administration’s plans for regulating health IT.

… To date, that image has been a bit blurry, although the general outlines are there. ONC Chief Don Rucker has made clear he is not a big fan of government regulation and at times has given the impression he’d rather not have to define information blocking at all. Over at CMS, Administrator Seema Verma has seemed somewhat more aggressive. Her agency has focused on trying to ensure greater patient access to data under its MyHealthEData initiative, but at the same time it has indicated a willingness to cut health care networks out of the Medicare program if they don’t accept interoperability mandates.

… It’s all clearly going to depend on the fine print.

WILL PRIVACY LAW SURVIVE?: As Pro subscribers who have been following coverage by Morning eHealth’s Darius Tahir of 42 CFR Part 2 (see here and here) know, the future of the federal privacy law covering records related to a patient’s treatment for substance abuse is very much up for grabs. It’s one of the most heated subjects of debate in the final opioid response bill that conferees from the Senate and House have been trying to iron out since the Senate last week passed its version of the bill.

… The House version (H.R. 6 (115)) allows clinicians and other providers to see those records— while severely penalizing any disclosures outside the health sphere. Advocates, including many Democrats and most Republicans, see the changes as key to enabling treatment of opioid abusers. Privacy advocates worry that such a change would threaten to spread sensitive health information to the four winds and in doing so, discourage people from seeking treatment.

… The Senate HELP Committee’s top Democrat, Patty Murray, has shown some resistance to the rule change. But her staff told us Friday that she did not outright oppose it, and might be willing to support a variation that assured privacy protections.

Tweet of the day: Ben Moscovitch @benmoscovitch This rule — coupled with one from ONC on APIs also @ OMB — could spark a turning point in the extraction & use of data. But, only if these rules can help fill the gaps (eg which data elements) & effectively address the barriers. Looking forward to seeing the details #healthIT

Welcome to Monday Morning eHealth. We’re writing this on the train from NYC, where we saw the #GermCity exhibit at the Museum of the City of New York, a peak vaccine nerd experience. It included a box of the actual ivory points used for smallpox vaccination in the late 19th and early 20th centuries. Made my deltoids tingle just to see ‘em! Share your vaccine and health IT nerdistry with [email protected], or tweet it @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

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WITHHOLDING THE DATA FROM ICE: The Trump administration has proposed expanding its crackdown on immigration by denying green cards to legal immigrants if they or their dependents have received certain forms of government assistance. The “public charge” rule posted by the Department of Homeland Security on Saturday allows it to deny residency even when an immigrant’s kids have gotten benefits — or if the government anticipates they may do so in the future.

… We’re hearing that this and other frightening news for the immigrant community may be lowering the veracity of data entered into EHRs. Kathy Zeisel, an immigration attorney who works with clinics in Washington D.C., told me recently that lawyers have been warning doctors not to include data about any government help immigrant families are getting—though information about such benefits is part of the “social determinants of health” assessment seen as key to care coordination. Immigration authorities can seize electronic health records as part of their investigations, Zeisel says. The District of Columbia provides health insurance for undocumented immigrants, but people worry that taking insurance could affect their immigration status.

… More to the point, the rule could force people to forgo medical visits until they are so sick they need to enter emergency departments, driving up the cost of hospital care for everyone, said Bruce Siegel, CEO of America’s Essential Hospitals, in a release. Members of the group often provide treatment for poor legal immigrants.

QUANTUM LEAPS TO THE WHITE HOUSE: Google, Microsoft and AT&T will be among the more than 100 attendees at Monday’s White House summit on quantum information science, Pro’s Stephen Overby reports. The meeting comes at an especially contentious time for the tech sector and President Donald Trump, who has accused internet and social media companies of being biased against conservatives. His administration has also imposed punishing tariffs that industry leaders say will raise prices and reduce U.S. competitiveness. More here for pros.

IN THE JOURNALS: Speaking of social determinants, a study performed in the Duke University Health System and published in JAMA Network Open found that integrating information about a patient’s socioeconomic status into their electronic health record doesn’t make it easier to predict their risk of ER visit or hospitalization. The authors studied about 90,000 patients from 2009 to 2016 and found those living in poorer neighborhoods were, as expected, more likely to visit or be admitted to the hospital for accidents, asthma, influenza, heart attack or stroke. But overall, the patients’ risks of all those conditions and hospital visits were just as easily obtained from EHR data.

… Putting an EHR into an orthopedic clinic reduces efficiency and productivity while reducing time spent with patients—even after an initial six-month implementation period, according to a study in the Journal of Bone & Joint Surgery.

… Now for the good news: Medical scribes were associated with decreased physician EHR documentation burden, improved work efficiency, and improved visit interactions, according to a report in JAMA Internal Medicine. It looked at two Kaiser-Permanente facilities in Northern California from July 2016 to July 2017 where scribes were implemented. “Scribed periods were associated with less self-reported after-hours EHR documentation” and a higher likelihood of primary physicians spending more than 75 percent of the visit interacting with the patient. Patients were also happy with scribes: only 2.4 percent gave them negative reviews.

PAIGING MSK, PAIGING MSK: Memorial Sloan Kettering Cancer Center’s leadership has sent an email to employees defending itself from a Friday New York Times/Pro Publica report that it gave for-profit Artificial Intelligence startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several center executives The health system said it was not sharing slides, only de-identified patient data, and said board members and faculty who own pieces of the partnership won’t be allowed to take part in decisions by the company.

CANCER DATA NETWORK GETS NEW MEMBERS: Ascension, Banner Health, Inova Health, LSU Health, OhioHealth and Seoul National University Hospital have each committed to sharing real-world evidence upon joining the Syapse Learning Health Network. They will join founding members Aurora Health Care, Catholic Health Initiatives, Dignity Health, Henry Ford Health System and Providence St. Joseph Health. The network, announced at a White House event in 2016, is a precision oncology data sharing network aimed at extending state-of-the-art cancer care beyond academic medical centers.

DATA PROVISIONS OF PAHPA: A final version of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018, H.R. 6378 (115), is due for House vote on Tuesday, Pro colleague Sarah Owermohle reports. The bill would reauthorize key HHS programs to develop responses to pandemics and biological threats. Among other measures, it requires the FDA to post on its website more details for drugmakers to request regulatory management plans, so companies can get agency feedback as they develop medicines and vaccine countermeasures. It also calls on HHS to convene experts to explore how genomic engineering can be used in the biodefense realm.

WHAT WE’RE CLICKING:

Forbes: Will Apple track your mind as well as your heart?

Medical Futurist: How autocracies could misuse digital health innovations

Health Data Management: EHR implementations need to involve doctors

CT Mirror: Docs say Connecticut HIE could help with opioid epidemic