VA’s Cerner project hits a snag

With help from Arthur Allen (@arthurallen202), Darius Tahir (@dariustahir) and Victoria Colliver (@vcolliver)

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Quick Fix

Privacy and interoperability were words of the week as patients, clinicians and regulators tackled difficult questions about right of access to health data and potential protections. Here’s what we’ve got:

— VA’s Cerner project hits a snag: The $16 billion EHR modernization effort faces significant delays, despite Veterans Affairs Secretary Robert Wilkie’s insistence that the administration is “on track.”

— Most Americans don’t trust doctors’ offices to secure their info: Just about a third of Americans have a “great deal” of trust that their doctor’s offices would secure their personal information, according to a new POLITICO-Harvard T.H. Chan School of Public Health poll.

— 42 CFR Part 2 proposal out: HHS this week proposed a set of revisions to a 1970s-era regulation governing the privacy of substance use records.

eHealth Twitter discussion of the day: Electronic Health Record Association, @EHRAssociation, “Current HHS rules don’t include certification for apps, though FTC regulates deceptive business practices online&on mobile. Once patient downloads their #ehealth data from an #EHR, it’s their decision what to do with it—& what gets done w/it. #interopforum https://www.healthcaredive.com/news/onc-in-talks-with-congress-white-house-on-third-party-health-app-privacy/561394/"

Laura G. Hoffman, @LGH_dc, “Unfortunately, it’s really not their choice. Current notice and consent models are flawed to the point of being meaningless. #Patients should get their #ehealth #data *and* have control over who else gets it. /1 #InteropForum #Privacy #PatientAccess”

IT’S FRIDAY at Morning eHealth where your author is glad to have met and seen so many health IT experts at the ONC interoperability forum that she’d only known from Twitter. If we still haven’t connected, drop a line at [email protected]. Tweet the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

VA ROUNDUP — The Veterans Affairs Department’s $16 billion EHR modernization project faces significant delays and unanticipated challenges, Arthur reports. The Cerner system’s promised March 2020 rollout is almost certainly to be partially or completely delayed until October, sources told Arthur. In a statement to POLITICO, the VA declined to say whether it would push the launch date.

...Also on the project, emails from senior Veterans Affairs staff released Thursday show frustration with three wealthy members of President Donald Trump’s Mar-a-Lago club — Marvel Entertainment Chairman Ike Perlmutter, attorney Marc Sherman and internist Bruce Moskowitz — and their potential influence over the health IT project.

“In one email, project head John Windom describes a meeting with the three as a ‘grin and bear it session,’” Arthur writes. “Another calls them ‘clearly out of their depth’ in demanding changes in the department’s 2018 EHR contract with Cerner that the officials felt were unreasonable.”

...In other VA news, Trump said he instructed the VA to buy “a lot” of an anti-depressant to help prevent suicide in veterans, but the FDA hasn’t yet approved that use for the drug — it also comes with severe warnings, Sarah Owermohle and Sarah Karlin-Smith report.

JUST 17 PERCENT OF AMERICANS TRUST INSURERS WITH DATA — That’s according to a new POLITICO-Harvard T.H. Chan School of Public Health poll gathering public opinion on health data concerns and access. Just about 17 percent were very trusting that insurers would secure their data; 24 percent had great trust in hospitals, and just a third reported the same for their doctors’ offices, Arthur writes.

The relatively high trust in doctors likely contributes to the growing use of patient portals set up by health systems. A quarter of adults say they have a portal, and most of those who signed up use them; about 59 percent used it to schedule an appointment, and two in five have requested a refill or gotten advice about a health problem.

HHS UNVEILS SUBSTANCE USE PRIVACY PROPOSALS — HHS’ proposed revisions are aimed at improving data-sharing on patients with opioid problems — it’s the third such attempt since 2017 to update a rule requiring explicit patient consent to share that data with doctors, Darius Tahir writes. Critics say 42 CFR Part 2 adds administrative burdens and endangers patient health by making medication and other history difficult to share. During a phone call about the release, HHS Secretary Alex Azar said the proposed changes wouldn’t fully align the 42 CFR Part 2 rules with HIPAA, as many officials in the health care industry want.

...On the HIPAA side of privacy, OCR Director Roger Severino is promising more enforcement action, Darius writes. The pledge comes after preliminary data from the startup Ciitizen last week showed that most providers weren’t compliant on patient data access requirements.

..."Access advocates say Severino’s actions have been mixed,” Darius writes. While Severino has “portrayed himself as an aggressive cop on the beat and spoken of his personal frustration trying to access his own medical records,” OCR has “also chosen to lower the fines for HIPAA violators that don’t show a persistent, willful record of failure. Advocates say that ruling has deprived enforcers of a critical set of tools.”

ONC leadership is also confronting difficult questions about HIPAA and how to ensure patient data doesn’t get into the wrong hands. They’re providing technical assistance to the Trump administration and bipartisan lawmakers on health app privacy, agency chief Don Rucker told POLITICO in an interview during ONC’s interoperability forum.

...Also at the forum, FDA’s Principal Deputy Commissioner and acting Chief Information Officer Amy Abernethy said Thursday that interoperability will be a key focus of the agency’s upcoming technology modernization plan, which will likely be unveiled in the next month or two. She also said interoperability could help health researchers pull real-world evidence from health records.

...Her comments follow a new Bipartisan Policy Center report published this week urging Congress to fund the FDA’s $60 million budget request for advancing real-world evidence. That report also said HHS should use APIs to export its data to researchers, providers and insurers.

NIH INVESTS IN GENETIC COUNSELING — The NIH is building a centralized hub that could end up advising tens of thousands of people on what to do with genetic information they get from the All of Us research program, Arthur writes. The agency The NIH will pay $4.6 million initially to California-based Color, a health technology company, to offer phone counseling to anyone who gets results from the study, which could contain potentially troubling news about genetic susceptibility.

Health IT Business Watch

ALLSCRIPTS JOINS APPLE BANDWAGON — The EHR company is now compatible with Apple’s health records feature, allowing patients to download data directly to their smartphones, it announced this week.

Names in the News

CALIFORNIA SENATOR SPARS WITH FACEBOOK — State Sen. Richard Pan, who was pushed from behind on Wednesday by an anti-vaccine activist who livestreamed the confrontation on Facebook, said he called on Facebook officials to remove the video from the site, but said the company refused.

Pan, the author of state’s 2015 law to eliminate all but medical exemptions for childhood vaccinations as well as a current bill to crack down on bogus medical excuses, told colleagues on the Senate floor on Thursday that the video was deemed “not violent enough” to warrant removal.

Sacramento police cited Kenneth Austin Bennett, who was seen pushing the senator and admitting in the video that he “probably shouldn’t have done that,” on a charge of misdemeanor assault and ordered him to appear in court.

“We want everyone using Facebook to feel safe — that’s why we have community standards and remove anything that violates them, including violent content,” A Facebook spokesperson said. “In this instance, after a thorough investigation, we determined there was no basis to remove the video as it does not violate our policies.”

DEEPMIND CO-FOUNDER OUT ON LEAVE — Mustafa Suleyman, who heads Google property DeepMind’s applied research division, has gone on leave by mutual agreement with the company. The artificial intelligence lab’s projects have focused on predicting health conditions including kidney injury; its National Health Service project, which gave the company access to more than a million patient records, led to scandal in 2017 when British regulators said the arrangement did not comply with data protection laws.


What We're Reading

— Nextgov’s Aaron Boyd reports on the VA’s five-mile-high EHR digitization backlog.

— WSJ’s Tess Riski writes about New York City’s burial records, which make public the names of women who had miscarriages, stillbirths and abortions.