Tribes denied coronavirus data

With help from Darius Tahir (@dariustahir), David Lim (@davidalim) and Tim Starks (@timstarks)

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Quick Fix

— American Indian tribes thwarted in efforts to get pandemic data: The communication gaps threaten to hinder their efforts to track the virus within populations prone to illness, disability and early death.

— More telehealth rumblings in Congress: The authors of the Cures Act foreshadowed upcoming measures to extend virtual care beyond the pandemic.

— On contact tracing apps, every state for itself: Google and Apple’s entry into contact tracing hasn’t done much to unite the states.

eHealth tweet of the day: Me: “I’m #HighRiskCovid19. Wear a mask, social distance.”
Nondisableds: “Stay home so we can reopen.”
My doctor: “We aren’t doing telehealth anymore because of reopening, you can’t stay home.”

It’s FRIDAY at Morning eHealth. Is your provider limiting telehealth as they reopen? Let us know at [email protected]. Tweet the team at @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Given the unprecedented public health challenge confronting regulatory affairs teams, the AgencyIQ leadership team has decided to pull research and analysis content concerning the virus and its regulatory implications in front of the paywall. It is available here: https://agencyiq.com/covid-19-resource-center/

Driving the Day

TRIBES DENIED CORONAVIRUS DATA — Native American tribes and organizations have been seeking coronavirus data ever since the spring — only to face barriers and difficulties from federal and state officials, Darius and our colleague Adam Cancryn report.

The CDC has turned down tribal epidemiologists’ requests for data that it’s making freely available to states. Authorities in Michigan and Massachusetts since early spring have also resisted handing over information on testing and confirmed cases, citing privacy concerns, and refused to strike agreements with tribes on contact tracing or other surveillance, eight tribal leaders and health experts told POLITICO.

In some instances, officials questioned tribes’ legal standing as sovereign entities.

“Because of the nature of the virus, which respects no physical boundaries, the ability to get the resources to where it’s being disproportionately felt is a way to protect the broader population as well,” said Rep. Denny Heck (D-Wash.), a prominent lawmaker on American Indian affairs.

LAWMAKERS PLUG CURES 2.0 EFFORT — The two authors of the 21st Century Cures Act are hitting the speaking circuit to gin up momentum for an encore.

Reps. Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) said Thursday they have received more than 500 comments in response to their request for feedback on what should be in the next piece of legislation. Tweaks to telemedicine and digital health regulations are pieces that could be included in the next stimulus bill, DeGette said.

“We’re trying to insert some of these ideas into a package in the next month or so,” Upton said. Others ideas will likely be left for next year “when things get to be maybe a little bit more normal.”

DeGette is hopeful that a discussion draft will be released this summer that could lead to a final bill and legislation for passage next year.

... Upton also name-checked his partnership with Rep. Jim Clyburn on a measure pushing the FCC to fund broadband deployment more rapidly. “This is a technology that we need to have all across the country and not discriminate against areas just because they’re poor and rural,” he said.

Follow the money: The FCC has committed half of the $200 million it was allocated for telehealth initiatives in coronavirus relief legislation that Congress passed in March, the agency disclosed.

Also this week, Reps. G.K. Butterfield and Glenn ‘GT’ Thompson dropped legislation that would codify Medicare’s telehealth reimbursement for safety net clinics. “Access to telehealth has become more than just a convenience, but rather a critical necessity in America,” Butterfield said in a news release.

Looking ahead to next week, UVA’s Karen Rheuban, American Telemedicine Association President Joseph Kvedar, Project Echo’s Sanjeev Arora, and BlueCross BlueShield of Tennessee’s Andrea Willis will testify before the Senate HELP committee on the pandemic’s lessons for telehealth.

In horrifying telehealth news: A software error allowed patients using the Babylon telehealth app to view other patients’ visits, though the company said only three users were affected, The Verge’s James Vincent reports. The startup has worked with the U.K.'s National Health Service.

... “This was the result of a software error rather than a malicious attack,” the company stated, noting that the issue had been resolved. “Of course we take any security issue, however small, very seriously and have contacted the patients affected to update, apologise to and support where required.”

STATES BALK AT APPLE-GOOGLE CONTACT TRACING TECH — Just a handful of states have committed to using Apple and Google’s Bluetooth-based contact tracing technology, but many more are still deciding or developing their own technology, your author reports with Tech’s Steven Overly.

The tech giants’ attempts to establish a nationwide contact tracing standard hasn’t exactly helped; some officials and experts warn that their technical restrictions, designed to protect privacy, could actually render the technology useless for public health.

... “Apple and Google’s incentive is to look like the good guys, related to the protection of privacy. That’s not a public health goal,” said Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics. Kahn said the companies have done little to address states’ concerns that they won’t get the data they need; several public health experts have argued that GPS location data, which would allow them to identify hotspots, would be more useful. “At the moment, it feels kind of one-way,” Kahn said.

And there’s still disagreement among public health and technology experts about whether Bluetooth proximity tracking or GPS data would be most helpful in pandemic response, said Daniel Weitzner of MIT’s Private Automated Contact Tracing research collaborative, which is using robots to test whether proximity tracking signals correspond to distances between devices. “We just have to learn based on real world pilots that can be studied and compared,” he told Morning eHealth.

... Some states are forging ahead anyway. Oklahoma and Virginia are among states signing up for Apple and Google’s API. Utah and Rhode Island are building their own apps, and North Dakota is doing both. But as states open up and Americans resume interstate travel, the apps could lose track of potential cases, experts warn.

“The more fragmentation there is, the less value there is,” said Bryan Sivak, formerly a chief technology officer for the Department of Health and Human Services under the Obama administration. “How do you effectively analyze the data to understand what’s happening?”

“It’s kind of a waste of resources,” he added. “We don’t need 50 apps to do this. We don’t need 10 apps to do this. We need one app that does it the right way.”

TRACKING THE TRACERS — Covid-19 contact tracing apps could be vulnerable to attackers who might use them to track devices, access sensitive information, send fake reports or intercept traffic, Check Point said in research out this week. “The jury is still out on how safe contact tracing apps are,” said Jonathan Shimonovich, Check Point’s manager of mobile research. “After initial review, we have some serious concerns.” The potential vulnerabilities include exploitation of Bluetooth technology or unencrypted communications to the backend server, Check Point found, although many existing app frameworks and protocols are emphasizing privacy and security and therefore “moving in the right direction.”

There’s another kind of security threat along these lines, too: fake contact tracing apps that are designed to look like government apps but are loaded with malware, 12 of which Anomali Threat Research identified on Wednesday.

MIT ENDS ELSEVIER NEGOTIATIONS — MIT has ended its negotiations for a new journals contract with Elsevier, the institute announced Thursday. MIT said the publisher couldn’t offer a proposal aligning with its commitment to open and equitable access to research.

... “I am disappointed that we were not able to reach a contract with Elsevier that honors the principles of the MIT Framework, but I am proud knowing that the MIT community — as well as hundreds of colleagues across the country — stand by the importance of these principles for advancing the public good and the progress of science,” Chris Bourg, director of the MIT Libraries, said in a news release.

NAMES IN THE NEWS — Sachin Jain, president and CEO of CareMore, is joining SCAN Group and SCAN Health Plan as its CEO.

What We're Reading

—HealthcareITNews’ Kat Jercich writes about cyber risks brought on by rapid telehealth rollouts.
—S&P Global’s Morgan Frey highlights privacy concerns as companies turn to apps to keep their offices virus-free.