CVS CEO’s vision for health

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As President Donald Trump backs away from the national emergency strategy, House Democrats are pushing short-term spending bills they hope could — maybe — end the shutdown. One bill is slated for discussion today. In health IT, “interoperability” and “privacy” are your Washington buzzwords. Here’s what we’re tracking:

— CVS CEO’s vision for health: Post Aetna-merger, Larry Merlo says CVS retail stores could feature telemedicine, remote monitoring and predictive algorithms flagging patients for preventive care.

— ONC posts interoperability document: ONC has crunched your comments and published a 2019 Interoperability Standards Advisory Reference Edition.

— Do we know how to use AI responsibly in health? A few researchers warn that we don’t, and recommend carefully examining artificial intelligence’s impact on bias and clinical safety.

eHealth Tweet of the day, including two patient record screenshots: Sherry Reynolds @Cascadia Comparison between mobile app and Apple Health app.

Health system app includes actual clinic notes and lets me message team, make appts, see labs, diagnosis etc - lets me accomplish tasks & engage

Apple Health only shows vitals, labs, diagnosis- shows limited static past data

Brian Eastwood @brian_eastwood: Replying to @Cascadia This seems to further reinforce that Apple Health is for healthy and “casual” users of health system who don’t actually need to engage with the health system.

It’s TUESDAY at Morning eHealth where your author is contemplating dusting off the crockpot and making soup. Your favorite cold-weather recipes and news tips go to [email protected]. Reach the rest of the team at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Fresh from the J.P. Morgan conference on the West Coast, CVS CEO Larry Merlo brought his vision for the combined CVS-Aetna entity — including wearable devices, push notifications and predictive analytics — to the National Press Club Monday. He also announced a $100 million, five-year program to fund community programs addressing the so-called social determinants of health and screening for chronic conditions. Here are a few of our other takeaways:

— Pricing data can push prescribers to suggest lower-cost alternatives to patients, Merlo said. For the past year, CVS has been unrolling EHR-based features that show participating physicians how much their patients would pay out-of-pocket for various drugs. About 40 percent of physicians switch to lower cost alternatives, the company’s early data suggests.

— Pharmacists could be the front-line caregivers at CVS’s concept stores. The company plans to open a handful of concept stores to test out new health offerings, including in-house phlebotomy, remote glucose monitors that can notify patients if their levels dip, and algorithms that could flag patients at risk of developing certain conditions and target them for preventive measures. The stores will also include a sort of “concierge” service to help patients understand their health benefits, though it wasn’t clear from his remarks whether those would be humans or computers.

Merlo added that the new stores would feature pharmacists “moving out from behind the counter” and screening for chronic conditions, and administering immunizations, among other services.

— CVS will still sell candy. The pharmacy stopped selling tobacco products in 2014, but candy, soda, chips and other snacks will remain even at these health-focused retail locations, Merlo said. He said the company had considered removing those items, but customers and medical professionals argued that they can be consumed safely in moderation, unlike tobacco.

MEET THE 2019 ISA REFERENCE EDITION: It’s been a little over two years since the wide-ranging 21st Century Cures Act was signed, and the discussion in Washington is turning back to interoperability. There’s still no movement on ONC’s rulemaking defining exceptions to the Cures Act’s ban on information blocking, but the agency did publish a pdf — the 2019 Reference Edition— updating standards and specifications for interoperability. Officials said they incorporated 74 comments on the ISA this year.

.. . Speaking of interoperability, what’s next? Lobbying group Health IT Now is hosting a congressional briefing addressing that very question Wednesday; ONC’s Elise Sweeney Anthony is slated to speak.

THIS WEEK IN TRANSPARENCY OVERSIGHT: Last week CMS took flak from lawmakers for not disclosing enough information about its innovation programs. This week, the focus is drug prices, our colleague Sarah Karlin-Smith reports.

House Oversight Chairman Elijah Cummings sent letters to a dozen drug companies seeking information and documents about their pricing practices as part of a sweeping investigation into pharmaceutical costs, Sarah writes.

Abbvie, Amgen, AstraZeneca, Celgene, Eli Lilly, Johnson & Johnson, Mallinckrodt, Novartis, Novo Nordisk, Pfizer, Sanofi and Teva were asked forcommunications on price increases, details of investments in research and development and corporate strategies to preserve market share and pricing power, Cummings said in a statement.

MORE THOUGHTS ON PRIVACY LEGISLATION: The Information Technology and Innovation Fund recommends a “repeal and replace” approach to privacy, eradicating existing federal privacy laws and instituting new protections that can preempt the patchwork of state laws, the group writes in a new paper.

Authors also recommended lawmakers set clear metrics for evaluating privacy legislation: the number of data breaches or identify theft complaints, for instance. They should “commit to revising legislation that fails to meet those thresholds,” the fund’s authors wrote.

DO WE KNOW HOW TO RESPONSIBLY DEPLOY AI IN HEALTH? In a new piece in BMJ Quality and Safety, researchers argue that the clinical value of artificially intelligent technology hasn’t yet been fully studied, partly because it’s difficult to quantify the benefit to patients or the impact on patient safety. That could lead to significant ethical challenges, they argue. Authors suggested posing questions including "[h]ow can we be sure the training data matches what we expect to see in real life and does not contain bias,” before deploying AI technology.

... speaking of AI, there’s a new PAC called “The Committee to Stop AI/The Machines from Killing Us All,” our colleagues at POLITICO Influence report.

URGENT CARE CAN CUT EMERGENCY DEPARTMENT VISITS: A new working paper suggests that urgent care centers are a cheaper substitute for emergency department visits for non-emergent conditions; after urgent care centers close, non-emergent ED visits rise by 1.43 percent, researchers find. Especially since urgent care has long been considered an opportunity for direct-to-consumer telemedicine, the research could be promising for telemedicine advocates.

The U.S. doctor who was exposed to Ebola in the Democratic Republic of the Congo three weeks ago did not develop the disease, and was discharged this weekend from a Nebraska hospital, where he had been monitored.

... And our colleague Alice Miranda Ollstein reports that a federal judge in Pennsylvania put a nationwide block on Trump administration rules allowing virtually any employer to deny workers’ birth control coverage, one day after a federal judge in a related case halted the rules in a smaller group of states.

OCR is hiring a Deputy Director for Health Information Privacy.

— A piece in Nature on using health insurance claims data to estimate genetic and environmental contributions to phenotypes

— WSJ’s Suryatapa Bhattacharya reports on Japan’s technology for elder care

— Anna Goshua writes in Buzzfeed on the relationship between medical students and the cadavers they dissect

— Bruce Booth reflects on the J.P. Morgan health care conference