Why telehealth isn’t in nursing homes

With help from Arthur Allen (@arthurallen202), Sarah Owermohle (@owermohle) and Mohana Ravindranath (@ravindranize)

PROGRAMMING NOTE: Morning eHealth will not be published from Monday, Aug. 26, through Monday, Sept. 2. We’ll be back on our normal schedule on Tuesday, Sept. 3.

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Quick Fix

— Why telehealth hasn’t spread to nursing homes: Admitting patients from nursing homes is often avoidable, possibly with a video visit. So why isn’t it happening?

— Genevieve Morris announces congressional bid: The former ONC and VA official is running as a Republican in Maryland’s second congressional district, she declared Tuesday.

— Watchdogs flag data problems: A pair of federal reports highlighted problems in two struggling projects: the VA’s attempt to bring scheduling software to the system, and the repository for national Medicaid data.

But first, the jump:

eHealth tweet of the day: GomerBlog @GomerBlog “BREAKING: Once a diagnosis gets put in an EMR note there’s no take-backsies.

#FOAMed #meded #emr #copyandpaste”

WEDNESDAY: With all the attention on the Trump administration’s cost transparency push, your correspondent can’t help but be a bit amused by this promotional T-shirt rebutting claims that — like the Danish cement sector — releasing health care data will lead to higher prices through collusion. (h/t Margot Sanger-Katz). Talk tees at [email protected]. Discuss promotional shirts socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

TELEHEALTH: WHY NOT IN NURSING HOMES? — Virtual care could save frail, elderly patients from being shunted from the nursing home to the emergency department – a trip that could disorient them and worsen their conditions, especially if it’s not necessary. But elder care facilities are hesitant to adopt telemedicine, and experts say it’s because there’s no clear payment model.

“The inherent benefits of telehealth have been made clear time and time again,” BDO’s Steven Shill told Mohana. But, “even if it’s a good idea, if you’re not going to get paid for it, it becomes a bad idea very quickly.”

Elderly patients’ discomfort with the technology shouldn’t be as large a barrier as some facilities make it seem, said University of Rochester’s Suzanne Gillespie, the lead author on a paper in the Journal of the American Medical Directors Association on telemedicine in nursing homes. “There certainly are some [concerns], same as there might be for many different populations, because it’s a different technology...but once you engage them, they seem to do quite well and like telemedicine care.

GENEVIEVE MORRIS: CONGRESSIONAL CANDIDATE — The former No. 2 official at ONC has jumped into the race to unseat longtime incumbent Dutch Ruppersberger in Maryland’s second congressional district.

Morris, who also helped the VA during the early phases of the Cerner EHR adoption, compares her policy philosophy to Maryland’s moderate Republican governor Larry Hogan. First, she’ll face off against Tim Fazenbaker, a conservative, in the primary.

WATCHDOG REPORTS — Watchdogs have some criticisms for two long-suffering health IT projects Tuesday:

VA scheduling: The VA’s Office of Inspector General on Tuesday released an eyebrow-raising history of VA’s nearly two-decade attempt to create a new scheduling system. The report notes that the VA decided it needed a replacement for its 80s-era VistA scheduling app in 2000, then spent nine years and $127 million on a homegrown solution that was never implemented, then launched another effort in 2014, but six months later hired Epic to create a new system.

As we’ve reported previously, Epic successfully built a prototype at the VA in Columbus, Ohio, but its $624 million, seven-year contract to build a nationwide VA scheduling platform was tossed out in April, along with the VA’s homegrown VistA Scheduling Enhancement project. Instead, Cerner was ordered to get cracking its own VA scheduling project, which is now scheduled to deploy nationally in 2023 (about four years before the rest of the VistA replacement ends—in principle, anyway).

— Data gaps: Gaps in the national Medicaid database make it impossible to conduct comprehensive studies on opioid use among beneficaries, a new analysis from HHS’s Office of Inspector General concludes.

Data quality in CMS’ Transformed Medicaid Statistical Information System, or T-MSIS, is poor, the report says. Some beneficiaries have multiple identification numbers, making them appear to be multiple people, and 19 states have gaps in provider identifier data; 10 of them entirely lack either provider or pharmacy identifying numbers, or both, the report says.

Without such data, it’s difficult to tell which patients are at risk of overdose, or which providers may be writing fraudulent or excessive opioid prescriptions, OIG said. T-MSIS has previously been the target of critical watchdog reports; GAO also called out the database’s data quality problems in January 2018. CMS has pledged to improve.

Research Corner

DIVERSITY DATA PROBLEMS — New studies are revealing a lack of health data pertaining to people of color:

— Cancer studies lacking: Cancer researchers are still failing to recruit people of diverse ethnicity and race to their clinical trials, according to a new JAMA Oncology study. Of the 230 clinical trials for drugs that were approved by the FDA from 2008 to 2018, only 18 divided the data by racial groups, and those that did showed they had trouble recruiting representative samples of minorities. White patients accounted for an average of 76 percent of the participants; Asians represented 18 percent, while Hispanics accounted for 6 percent and blacks just 3 percent of the cancer trial participants.

— JAMIA on missing data: A new study in the most recent Journal of the American Medical Informatics Association demonstrate there’s a lot of missing data on race and ethnicity in large datasets — and that that might be biasing research.

In the study, authors examined patient information from EHRs and large observational databases — from Optum, the Healthcare Cost and Utilization Project and an unnamed New York City health care system — and found large percentages of the records lacked race and ethnicity information. For example, 57.9 percent of patients in the New York City health care system lacked such data. That means that researchers may encounter difficulties in trying to accurately report disparities in health care, the study argues.

STANDARDIZING SOCIAL DETERMINANTS — A new part of standards group HL7’s accelerator group will focus on standardizing medical codes for data about patients’ food, housing and transportation. The initiative, called the Gravity Project, evolved from a discussion within the University of California-San Francisco’s Center for Health and Community.

Working with HL7, which has helped push the buzzy FHIR standard underlying many new interoperability efforts, could help ensure that providers, patients, community groups and insurers better exchange data, said Laura Gottlieb, a UCSF associate professor who works in the area, in a news release.

Health IT Business Watch

FACEBOOK ROLLING OUT PERSONAL DATA-CONTROL TOOL — The social media giant is debuting a new tool to give users control over how their data is used by third-party advertisers, our Europe colleague Mark Scott reports.

The tool, initially limited to Spain, Ireland, and South Korea, will limit advertisers’ ability to target users on Facebook and not on the broader web.

Facebook has been under fire for its privacy protection standards. The company’s health care initiatives have been panned, with users of its patient groups arguing that the company’s privacy tools did not prevent advertisers from seeing the membership of groups organized around specific medical conditions.

PERSONNEL NOTES — James Peake, the secretary of Veterans Affairs between 2007 and 2009, has joined the Bipartisan Policy Center as a senior fellow on their health team … Vid Desai, formerly an IT executive at medical device firm Vyaire Medical, is FDA’s new chief technology officer … Simon Mouyal, previously the chief marketing officer at Medidata, has joined athenahealth with the same title. … Former Planned Parenthood head Leana Wen is a visiting professor at George Washington University’s school of public health.

What We're Reading

Apple Health team running into tensions, CNBC reports.

An editorial in Nature Digital Medicine unearths an “inconvenient truth” in AI in health care.

Kaiser Health News investigates the collapse of a rural health care chain.