What telehealth brings to opioid use treatment

With help from Darius Tahir (@dariustahir)

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Quick Fix

— What telehealth brings to opioid use treatment: Researchers called for deeper investigation into the costs and benefits of virtual care for substance use disorder.

— Bad state data hides coronavirus threat: Health departments in at least a dozen states have inflated testing numbers or deflated death tallies by changing criteria.

— CARIN Alliance’s new health app project: The multisector group has posted several apps patients can use to collate data from insurers and providers.

eHealth tweet of the day: Sara K. Runnels @omgskr “The worst thing about returning to bars will be getting a standard 5-ounce pour of wine instead of the 25 ounces my home-bar offers”

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Driving the Day

RESEARCHERS ON TELE-MAT: GROWTH MAY PRECEDE EVIDENCE — With virtual treatment for opioid use disorder likely on the rise, a group of researchers this week noted that some key questions remain unanswered: How does the technology impact treatment retention, effectiveness, and costs?

“As with many telehealth innovations, growth may occur before the evidence base is strong,” authors wrote in JAMA commentary.

Maintaining access to medication is especially important during the pandemic, and recent federal policy has relaxed restrictions on the remote prescription of controlled substances. Depending on the treatment program, virtual care could involve video, texts, apps and home drug tests that patients share on screen.

At least in theory, virtual care means patients don’t have to negotiate transportation, childcare and the stigma associated with in-person visits. But telehealth can also pose challenges for patients in chaotic home environments, especially if they lack privacy, authors point out.

"[A]lthough studies are in progress, there are currently no data to demonstrate that telehealth services provided in the home for the treatment of OUD are effective,” authors write.

... Their commentary comes as telehealth providers and patients worry that recent policy changes — including a temporary waiver of the ban on telehealth prescription of controlled substances — will be rolled back once the public health emergency period ends. And DEA has yet to publish a permanent rule outlining a special registration process for doctors to prescribe controlled substances remotely, despite an October 2019 deadline from Congress.

... Telehealth outreach for Latinos: UCLA researchers are urging California policymakers to increase access to virtual care in safety net programs, part of an effort to use the technology to reduce health disparities among Latino communities.

“Latinos, who are twice as likely to lack health insurance than other Californians, are increasingly online and have high adoptions of cell phone technology,” said UCLA’s Sonja Diaz in a news release. Virtual care could “serve as an important bridge to ensure that underserved communities, especially rural and linguistically diverse patients, access the medical attention they need, particularly during the pandemic.”

In the world of broadband, House Democrats disagree about whether the FCC should fast-track the timeline for allotting $16 billion in rural broadband subsidies this year, our POLITICO colleague John Hendel reports.

The current schedule would let telecom providers start bidding on Rural Digital Opportunity Fund subsidies starting in October. House Majority Whip Jim Clyburn unveiled H.R. 7022 (116) this week to award some of those funds as soon as the summer. “Let’s do it now,” Clyburn told reporters on a call Thursday. “The money is there.”

But his push contradicts warnings from Energy and Commerce telecom subcommittee Chair Mike Doyle (D-Pa.), who tweeted Wednesday that the FCC plan “will fail to get broadband to the places that need it most.”

The FCC “needs to fix their maps before they waste billions,” Doyle cautioned. Republicans, meanwhile, have contended that flawed mapping accurately measures the underserved areas that are eligible.

Doyle’s view would be “fine if we did not have this pandemic,” Clyburn said. “Why wait?”

WHAT’S UP WITH THE DATA? — Across the nation, federal and state officials have altered or concealed data critical to tracking the coronavirus, Darius and our colleague Adam Cancryn report. The trend — whether through hiding data about outbreaks in nursing homes and meatpacking plants, mixing together different types of tests to inflate testing capabilities, and more — concerns public health observers.

“All these stories about undercounts, overcounts, miscounts, are undermining our ability to deal with the pandemic,” said Irwin Redlener, a public health expert at Columbia University. The country, he said, is confronting an “unheard of level of chaos in the data, the protocols, the information.”

The problems, which also include fired scientists and misused models, are widespread at both the federal and state levels. They’re also unusual.

“I have never seen politicians come in like this and question the science,” said Melissa Marx, a public health professor at Johns Hopkins University and former CDC official. “In my mind, it’s unprecedented.”

And it may mean less trust in public officials as the pandemic progresses.

CARIN ALLIANCE FEATURES FIRST BATCH OF APPS — The “My Health Application” site aims to help patients choose apps to manage their health data; the first several to be featured include apps from the Veterans Health Administration, CMS Medicare Blue Button and Apple Health.

“We envision a future where any consumer can choose any application to retrieve both their complete health record and their complete coverage information” from providers and health plans securely and in a way that meets their privacy and sharing preferences, CARIN Alliance said in a blog post.

... “With the final @CMSGov @ONC_HealthIT rules, we can drive app adoption of stronger patient privacy protections,” CARIN Alliance co-founder Aneesh Chopra tweeted Thursday.

In other app news, Arizona has sued Google for location data collection practices. Attorney General Mark Brnovich tweeted that the consumer fraud lawsuit was for “deceptive and unfair practices used to obtain users’ location data, which Google then exploits for its lucrative advertising business.”

... This comes just days after Apple and Google unveiled an API states can use for Bluetooth-based proximity tracking; the tech giants have resisted pressure from states to allow GPS data collection, part of an effort to assuage privacy concerns.

Also on privacy, about 47 percent of respondents in a recent Venrock survey think the health care industry is about to face backlash for violating patient trust by gathering and re-selling data.

... And a report fromEY and the International Association of Privacy Professionals finds that most surveyed employers have gathered information from employees about personal travel and symptoms; 60 percent are keeping records of employees who are diagnosed with the virus.

VA CLAIMS PPE SUCCESS, WON’T COMMIT TO EXPANSION — VA Secretary Robert Wilkie on Thursday told House appropriators his department has boosted supplies of protective gear for its health workers but wouldn’t commit to changing guidance for using gowns and masks, which subcommittee chair Debbie Wasserman Schultz characterized as “austerity measures.”

Wasserman Schultz said she was troubled by whistleblower reports that health workers were reusing masks or laying them out in the sun to disinfect them, and pressed Wilkie for a formal guidance expanding the use of PPE, which Wilkie did not explicitly commit to. The agency says it has substantially built up its PPE stores.

What We're Reading

— Camille Sojit does a deep dive on chatbot mental health apps for Gizmodo.

— Reuters’ Foo Yun Chee reports on the Belgian privacy watchdog’s objection to the country’s coronavirus response efforts.