Core data set recommendations advance at HITAC

With help from Arthur Allen (@arthurallen202) and Mohana Ravindranath (@ravindranize)

CORE DATA SET RECOMMENDATIONS ADVANCE AT HITAC: The HITAC voted Wednesday to approve nine recommendations from a specialized task force on updating the list of data elements that vendors must exchange to be considered interoperable. The U.S. Core Data for Interoperability standards, and the process for updating them, will eventually flow into the Trusted Exchange Framework and Common Agreement draft. (TEFCA, when final, will outline a shared agreement health information networks can use to exchange data.)

Now that they’ve been approved, the HITAC recommendations will go to ONC in a letter that its staff will consider while crafting TEFCA. The recommendations include establishing a six-stage process from the proposal of a new data element to its eventual addition to the core data set, and publishing the USCDI annually with bulletins as elements progress through those stages.

UPHEAVAL CONTINUES IN VA IT RANKS: The shuffle at Veterans Affairs continues as there’ll be some new faces involved with the department’s electronic health records — at least, we presume.

— New acting CIO: As our colleague Arthur Allen first reported, the VA’s new acting chief information officer is Camilo Sandoval. Sandoval, formerly a director of data operations for President Donald Trump’s 2016 campaign, was accused by a colleague of executing a “slander crusade” against her, which included sexual discrimination.

Sandoval also served as an Air Force intelligence officer, among other positions, and presumably will help shepherd the implementation of the new electronic health record.

— ONC’s Morris (part-time) to VA: ONC principal deputy national coordinator Genevieve Morris will be wearing two hats for a while, as she’s been detailed to the VA, an ONC spokesman confirmed Wednesday. He couldn’t comment on Morris’s precise role in her temporary position — and a VA spokesman didn’t immediately reply to a request for comment — but did emphasize that she remains involved with her TEFCA work at ONC.

eHealth tweets of the day: Quite Interesting @qikipedia “The NHS uses more than 10% of the world’s stock of pagers.”

Grant Fitzner @GrantFitzner “The #NHS also world’s largest purchaser of fax machines. Relying on old tech because after the Connecting for Health fiasco, few trusts willing to risk creating a modern electronic patient record system. Even if they wanted to, cuts in capital budgets make it difficult to afford”

THURSDAY: Spring is raring up here in the District and it’s time for your correspondent to singlehandedly save the generic drug industry’s business model, as he is now the #1 purchaser of anti-allergy therapies. (No one check this fact.) Please share other ways of getting your fix at [email protected]. Discuss other habits profitable for the drug industry at @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

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PDMP NOTES: Some updates to share from the world of prescription drug monitoring programs and opioids:

— National report: A new report from the National Safety Council examining states’ approach to the opioid crisis gives high marks to PDMP policy, while faulting other aspects of their approach. 39 states meet the Council’s criteria for advanced use, which included interstate data-sharing and delegate access to the program. However, only seven states are doing well by the Council’s lights on data collection: they’re the only states requiring the reporting of drug overdoses.

— Kansas: Opioid prescriptions dropped by nearly nine percent in 2017, state officials using their PDMP announced earlier this week. They’ve also been active in integrating the PDMP with the EHR, with about 50 facilities benefiting statewide.

— Missouri: We’ll likely be waiting another year for a statewide PDMP in Missouri as the State Senate cut funding for the program earlier this week.

FARM BILL BOOSTS TELEMEDICINE: The latest farm bill, passed Wednesday by the House Agriculture Committee, includes a couple of boosts for telemedicine. The bill increases Department of Agriculture appropriations for distance learning and telemedicine by $82 million, while re-authorizing the program through 2023. Ten percent of funds are reserved for the rural health emergency — understood to be the opioids crisis.

PEAR THERAPEUTICS INKS AGREEMENT: Pear Therapeutics — the digital health startup that snagged the FDA’s thumbs-up for its substance use disorder — treatment app — has sealed a partnership with pharmaceutical firm Sandoz, a division of Novartis. The app helps provide cognitive behavioral therapy for patients in outpatient treatment. Pear also has been collaborating with FDA’s pre-certification pilot program for software developers.

UPDATES ON LONG-RANGE DEVELOPMENTS: Let’s keep you apprised of a couple long-range developments we teased yesterday:

— Rescission package to be unveiled, OMB director says: OMB’s director Mick Mulvaney says the White House is still on track to formally present a package of spending cuts to Congress in the next couple of weeks, even though GOP members have forcefully denied their interest in the stratagem. The White House reportedly has been considering as much as $60 billion in cuts to the budget that President Trump signed in February, though it’s not yet clear where they’d come from.

— Test case of guidance repeal succeeds: The Senate’s effort to roll back guidance under the Congressional Review Act succeeded Wednesday, as it axed an auto-lending guidance from the Consumer Financial Protection Bureau. The action potentially opens up a vast swath of agency work to Congressional disapproval.

NEW IN NEJM: A new issue of the New England Journal of Medicine has a couple items of interest:

— Performance measurement: Only 37 percent of metrics used by MIPS were found to be valid – that is, important and backed by evidence, among other criteria – an article in the New England Journal of Medicine claims. Some of the measures, if followed, would require vast work but have little evidence to back them up: the authors cite a measure requiring elder maltreatment screening as an example, as the U.S. Preventive Services Task Force has not found enough evidence to warrant routine screening.

Performance measurement is at the heart of physician complaints about our new digital age, in part because the burdens of reporting data to qualify for strong (or not so strong) ratings are so high. The authors conclude with a request for a time out.

MIPS has already been deemed in need of an overhaul by the Medicare Payment Advisory Commission. And the American College of Physicians has called for a simplification of MIPS, which penalizes some doctors up to 9 percent for not hitting performance benchmarks.

AZAR BACK IN THE HOSPITAL: HHS secretary Alex Azar was back in the hospital Wednesday, the department announced, as he’s been suffering from diverticulitis.

WHAT WE’RE CLICKING ON:

Nurses in D.C. will be staffing the city’s 911 line and dispatching Lyfts or taxis when appropriate, the Washington Post reports.

African scientists want more control, and less “helicopter science,” in genomic research on the continent, according to a news article in Nature.

Jeff Bezos is very interested in direct primary care, STAT reports.

An exploration of Facebook’s use of health data from a Rice University scholar in the Washington Post.

Sleuths are using genomic sequencing, among other methods, to put names to the unidentified dead in American military cemeteries, the New York Times reports.