Week preview: HHS appropriations coming

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

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Quick Fix

Another busy week is coming our way — fast. Here’s what you’ll need to know:

— Week Preview: We’ve got a busy week coming, highlighted by appropriations for HHS in the House, more ONC task force meetings, and developments at the American Medical Association’s annual meeting.

— One more batch of comments: The latest – and surely nearly the last – comments have been posted in response to ONC’s big information blocking rule. The Federation of American Hospitals, UnitedHealth Group, and FTC all have some fairly strong critiques.

— Telemedicine-assisted abortion study: Abortion medication prescribed through a video call is just as safe and effective as providing it after an in-person consultation, a new study shows.

And more. But first, the jump.

eHealth tweets of the day: Enrico Coiera @EnricoCoiera [on our colleague Arthur Allen’s report about Epic’s troubled introduction to Denmark] “Repeat after me, digital solutions are never just technical. They are always socio-technical. “Epic might work in the United States ... but its design was so hard-coded in U.S. medical culture that it couldn’t be disentangled.”

Ben Moscovitch @benmoscovitch [in reply] “This is critical. There are technical solutions that would fix interoperability, EHR usability, patient identity/matching, etc. But those start to break down once people, motivations, workflows, business drivers, & other factors are added to the mix”

MONDAY: Hope everyone had a restful and fun weekend. Your correspondent’s still numb after insisting he eat the “extremely spicy” version of the papaya salad at Thip Khao. It was all worth it! Talk spicy food at [email protected]. Discuss spiciness socially at @arthurallen202, @dariustahir, @ravindranize, @POLITICOPro and @Morning_eHealth.

Driving the Day

WEEK AHEAD — We’ve got a busy week percolating. Here’s the stuff to watch:

— Appropriations: We’ll be seeing a lot of appropriations action this week with the House due to consider appropriations bills for HHS. The early focus will be on the House Rules Committee, which on Monday evening will decide which of myriad amendments that have been filed will get debate time. One to watch would repeal the longtime ban on the use of government funds to develop a national patient identifier.

— ONC task force meetings: It’s a busy week on tap for ONC’s task forces: there are two meetings of the Trusted Exchange Framework task force on Tuesday and Thursday. Its activity is worth monitoring with an approaching general deadline of June 19 for comments on the office’s hopes to create a structure which can facilitate data exchange between different health information exchanges.

Also this week: an interoperability standards priorities task force meeting on Tuesday, and a U.S. Core Data for Interoperability Task Force meeting on Friday.

— American Medical Association meeting: The AMA’s annual gathering of its House of Delegates is ongoing this week. The delegates will consider several digital health subjects.

The tone has already been set. In a Saturday speech, the physician lobby’s president Barbara McAneny criticized several parts of the U.S. health care system — with EHR and digital health naturally drawing their share of critiques.

McAneny praised the diabetes prevention program — an interest of several startups — and the association’s work on reforming prior authorization requirements.

Of note: Nestled in a section decrying how mergers and acquisitions are creating a closed, uncompetitive market, McAneny gave a mention to EHRs: “We all look forward to the day when electronic health records are a useful tool instead of a glorified billing machine, but the EHR market is very concentrated and powerful.”

ONE MORE BATCH OF COMMENTS — There’s another batch of comments on ONC’s big information blocking rule rolling in, and the tone is somewhat negative. The Federation of American Hospitals, UnitedHealthcare and the FTC have all weighed in on the rule, and they are each, in their own way, critical of the office’s proposal.

—Federation of American Hospitals: The Federation, which represents for-profit hospitals, wants ONC to take it slow, asking for a supplemental rulemaking to flesh out some of the unclear parts of the proposal and, further, delaying implementation of enforcement for at least a year and a half following the supplemental proposal. They also want the government to reach out to providers and other affected groups to explain how enforcement would work.

But the Federation doesn’t stop there. Like other commenters, it suggests ONC has gone too far in its definitions of electronic health information and other key terms. Unlike other commenters, it goes farther in saying the definition isn’t merely unwise, it’s also legally questionable, because the definition of EHI “extends beyond the authority granted to the Secretary in the Cures Act.”

— UnitedHealthcare: The insurance giant also complains key definitions are overbroad, but suggests the agency set explicit caps on fees for data exchange — a regulatory step further than the agency’s proposal for merely “reasonable” fees.

— FTC: Finally, the Federal Trade Commission has some critiques, arguing in a letter that the rule needs tightened definitions and greater clarity. Like the Federation, it thinks the office’s definitions of electronic health information, and other terms, are overly broad; and like the Federation, it would like more specific examples.

TELEABORTION STUDY — Medication abortion is just as safe when prescribed by a provider over video as in-person, a new study in the journal Contraception shows. The study screened 433 women in five states, of which 248 were mailed the drugs, while the other arm received the pharmaceuticals in-person.

The success rate was similar in both arms of the study; in the teleabortion arm, 8 percent had to visit the emergency department.

The study’s sponsors hope the results will convince the FDA telemedicine to allow the drugs to be mailed to patients, which is currently restricted. The agency has been investigating some not-for-profits providing medication abortions to Americans.

WHAT WATSON’S DOING ABOUT OPIOIDS — IBM’s flagship AI system Watson has stumbled in the health market recently; the company shuttered sales for drug discovery and lost a top exec last year following layoffs. Despite setbacks, IBM sees an opportunity for its Jeopardy-winning AI in the opioid crisis, and has been crunching claims data for employers and government agencies looking for ways to reduce overdoses.

Rachel Henke oversees IBM Watson’s research for government agencies including CMS and SAMHSA; the company has a database filled with de-identified Medicaid and commercial claims information that customers can tap to answer specific questions about the opioid crisis, she told Morning eHealth.

Government agencies, especially state Medicaid programs, may work with a Watson team to track opioid prescriptions over time, or examine trends in treatment.

“The main question is what works,” Henke said, explaining that IBM’s claims database can highlight hot spots for opioid hospitalizations or emergency department visits. “What are the key policy levers that are effectively reducing this?”

STATE AGs LAUNCH LAB BREACH INVESTIGATION — The Connecticut and Illinois attorneys general announced Friday they’re investigating the lab breach of as many as 20 million patients’ records at LabCorp and Quest Diagnostics.

The breach originated at the firms’ third-party debt collector, the American Medical Collection Agency. The companies say limited financial information, not medical data, was breached.

What We're Reading

Genetic testing might be the next big area for fraudsters, warns a former assistant U.S. attorney at STAT.

Meals on Wheels expands smartphone-based program, the San Diego Union-Tribune reports.

Could AI improve asthma care, asks a pediatrician in MIT Technology Review.