Rucker talks agenda before E&C
With help from Arthur Allen (@arthurallen202) and Mohana Ravindranath (@ravindranize)
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RUCKER TALKS AGENDA BEFORE E&C: Tuesday’s House Energy and Commerce health subcommittee hearing on 21st Century Cures oversight got testy, with lawmakers grilling ONC head Don Rucker every which way. Rucker ended up providing a peek into the office’s agenda for the coming months:
— Where’s the rule?: Panel members were, shall we say, not amused by the still-nowhere-to-be-found information blocking rule.
“It’s hard to explain that Congress has provided the tools necessary for doctors and patients to better share data but nothing has changed,” said subcommittee chair Michael Burgess (R-Texas).
But Rucker had to explain that the rule has been parked at OMB — since September, in fact — and for whatever reason the valet hasn’t retrieved it. So he’s annoyed too, but he can’t really do much about it. We’re all waiting.
— ADT chatter: During some long chatter about how the government can extend health IT benefits to behavioral health providers, Rucker corroborated some earlier reporting about the government’s health tech agenda.
Noting that while CMMI — due to the SUPPORT Act ( H.R. 6 (115)) — will have future opportunities to help extend tech, Rucker argued that the government has an opportunity to improve things rather simply making sure admit, discharge, and transfer (or ADT) data is disseminated through health information exchanges that tell doctors when their patients have been hospitalized. That might help for patients admitted for a drug overdose.
“There may be low-hanging fruit and we are looking at how to expand that,” Rucker said. His comments back up our earlier reporting about last week’s White House interoperability meeting, during which CMS Administrator Seema Verma stated that the government is hoping to promote more fulsome release of ADT data.
It’s “not enough,” said Al Guida, a lobbyist for the Behavioral Health IT Coalition, noting increased usage of EHRs was a critical prerequisite for safe expansion of medication assisted treatment. Such treatment can be most safely used if prescribers check whether there are any patient allergies or interfering medications — both of which are best with an EHR.
— Part 2 questions: Rep. Markwayne Mullin, a determined advocate for an overhaul of 42 CFR Part 2 (a provision which prevents substance use treatment data from being shared without explicit patient consent), tried to pin Rucker down on his position about possible reforms.
Rucker managed to mostly escape, deferring to SAMHSA as the lead agency on the subject. But he admitted that providers struggle with knowing which patients are covered by the provision, and said, “I think HIPAA does a great job with privacy.” (Advocates for Part 2 changes believe HIPAA standards are a more appropriate privacy standard for health data.)
eHealth tweet of the day: Nick Dawson @nickdawson “[on reports of errors in medical records] I’ve been thinking about a GitHub model for medical records. What if patients owned them and granted “contribute” rights to providers for pull requests. Then contributions could be reviewed and accepted. You could even have forking - eg for research.”
WEDNESDAY: Your correspondent hopes we’re all having a nice holiday party season. One suggestion for a scintillating conversation topic, sure to provoke sparkling repartee from all: What’s the difference between an overtone and an undertone? Your correspondent doesn’t know himself! Suggest other topics for aspiring raconteurs and wits at [email protected]. Discuss discussions at internet site where discussions about discussions occur: @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.
ARE OUR MACHINES LEARNING?: At a semi-private event Tuesday at the Google Cloud Office in Washington, White House, HHS and VA officials revealed a plan to make data available for machine learning across federal agencies. The plan will be discussed further at a health “Demo Day” on Feb. 7 at the Department of Commerce, a source at the meeting told POLITICO.
A Presidential Innovation Fellow working with the VA presented a “multi-cloudal” architecture plan for big data science in the government, involving VA and Cerner data as well as Department of Energy facilities. VA is starting a data pilot with its de-identified health data, and it will be put to use soon to help combat suicide and PTSD in the veterans population, according to a slide presentation.
The February event is the culmination of a “tech sprint” that presidential innovation scholars kicked off in October to transform federal open data from HHS, the VA and other agencies. It’s intended, among other things, to assist in clinical trials. More details here.
— Forced out: Peter O’Rourke, one of the VA officials involved in the internecine feuds at the top fo the department, was forced out, The Washington Post reported Tuesday. O’Rourke was an ally of the Mar-a-Lago crowd, which had its hands in everything from the VistA/Cerner decision to app development.
— Cassidy bill: Sen. Bill Cassidy introduced a bill to shake up VA medical and surgical supply purchasing Tuesday. The bill, called the “Veterans Affairs Med5 ical-Surgical Purchasing Stabilization Act,” would move the department from a nationwide prime vendor structure to a regionalized one.
ELSEWHERE IN THE ADMINISTRATION…: A bit of this and that:
— OCR: HHS’s Office for Civil Rights handed down a $110,400 fine to the Pagosa Springs Medical Center, after it was discovered that a former center employee still had access to its protected health information. This resulted in the impermissible disclosure of 557 individuals’ data. Office director Roger Severino called the error “common sense” in a statement announcing the decision.
The action is the office’s sixth move related to digital technology in 2018; OCR has taken in $24.5 million so far in those cases, compared to a previous high of $23.2 million in 2016. Overall, the Office has ten settlements and fines related to HIPAA this year.
The fine is the office’s fifth in 2018; it’s taken in a bit more than $24 million so far. That moves this year’s haul further past the office’s previous high: in 2016, it totaled $23.2 million. However, the number of fines under Severino has slowed: if the office doesn’t announce any more fines this year, it’d be its slowest year by that metric since 2014.
— Shutdown threat?: We’re back on shutdown watch as President Trump threatened on Tuesday to not sign a funding bill if it doesn’t devote money to a border wall between the U.S. and Mexico.
MEDICAID PACKAGE PASSES HOUSE: A package of Medicaid bills passed the House Tuesday. For tech watchers, the ACE Kids Act ( H.R. 3325 (115)) is the most relevant piece of legislation. The bill seeks to encourage state Medicaid programs to fund care coordination entities, which would cover provider efforts to coordinate care for kids with complex conditions. The bill is based on a CMMI demonstration utilizing similar principles; providers who won CMMI awards were able to reduce costs and improve care. As you can probably guess, the providers tried to use tech tools ike registries and data analysis.
Here’s a Health Affairs blog post from the CEO of the Children’s Hospital Association (which advocated for the bill) describing how awardees better coordinated care.
PDMP WATCH: A few notes from the state of prescription drug monitoring programs:
— Oregon: An Oregon state auditor is recommending big overhauls to its prescription drug monitoring program, including eased data-sharing with law enforcement and other institutions, in a new report.
That report argues that the PDMP is either barred, or finds it difficult, to share relevant prescription data with state licensing boards or law enforcement. That in turn complicates authorities’ ability to curb doctor-shopping, the report continues. “Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” the report says. (Nationwide, there’s some debate over whether this is a wise approach, as we reported in June.)
The report would also like the PDMP to produce prescriber report cards, and for a prescriber mandate to check the database.
— More economic evidence: A new study in the American Journal of Health Economics corroborates the emerging consensus on PDMPs: merely making the database available to providers doesn’t have an effect. It takes requiring providers to check it. But that effect is mixed: states that require PDMP checking see double-digit percentage declines in opioid prescriptions and deaths but increases in illegal drug deaths. (The evidence for an increase due to illegal drug deaths is somewhat more uncertain, the author cautions.)
Will Canada also axe the fax, asks columnist Andre Picard in the Globe and Mail.
An exec for the Children’s Health System of Texas, Katherine Lusk, says interoperability is possible now.
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