COVID’S DATA WAKE-UP CALL: It was supposed to be simple: Labs reporting Covid-19 test results at the start of the pandemic were to use just one of two codes. Instead, some hospitals got 200.
That digital clutter from human coding errors required a huge investment of time and staff to clean up. It was just one example of the chaos enveloping the nation, as officials, hospitals, and doctors looked for a clear picture of what was going on. Often they were buried underneath faxes, which were slow to arrive and missing critical information.
Now the federal government — pushed by public health and techies — is considering how to overhaul its rickety health IT systems. More digital means of communication would replace systems that left states relying on fax machines and paper records for critical tasks like contact tracing. Some states even had to call up their National Guard to manually enter data. Going digital, though, means prodding labs, hospitals and providers to use standardized tech systems. And in U.S. health systems, public or private, that hasn’t always been quick or easy.
Micky Tripathi, the leader of HHS’s health information technology office, has convened a task force to make recommendations. One idea under consideration is having the federal government and the states share a computing infrastructure, allowing public health departments to more easily share data and novel software programs.
“The pandemic exposed the boulders underneath the water, “ Tripathi told Future Pulse. “We can now understand where to invest.”
The modernization efforts actually predate Covid, starting in earnest when congressional appropriators first secured money for updating public health technology in 2019. But the pandemic exposed critical shortcomings, prompting Congress to send additional tranches of health tech dollars in relief packages and annual spending bills. As much as $100 million more is contained in a House health spending bill for fiscal 2022 soon headed to the floor.
The question is whether it will deliver results in time. Some outside experts say the Centers for Disease Control and other agencies have been slow to respond to the newfound largesse. “I’ve seen allocations, such as >$1B for genomic surveillance data, but not a penny put to work,” wrote Eric Topol, founder and director of the Scripps Research Translational Institute, in an email. And funding for public health is often siloed, going to specific diseases rather than overarching technology.
The concern is driven by what experts say is a familiar pattern of throwing lots of money at a crisis, followed by inattention and lapses in resources. “I’m a bit worried [the momentum] will die,” said Shannon Sartin, an executive with CIOX Health who previously worked in government health technology.
Further complicating matters is the hardening resistance on the political right to the federal public health response. Such sentiment could complicate the envisioned modernization of the immunization registries — the workhorse databases that help track inoculations — warned Rebecca Coyle, the head of the American Immunization Registry Association.
Upgraded registries could help officials track flu vaccination campaigns or share data across state lines, she said. But whenever vaccines come up, “you get a huge influx of anti-vaxxers who will do their best to derail anything,” she said. That impairs coordination between vaccinators and others in the public health community.
Jen Horonjeff | #askpatients @jhoronjeff “We can send another billionaire to space today, but I get sent my medical records [in disc form]
Do any of them have a time machine so I can go back to 1998 and use a CD-ROM?”
ASK THE EXPERT: WHAT TO MAKE OF VACCINE MISINFORMATION AND SOCIAL MEDIA?: President Joe Biden’s public brawl with Facebook over Covid vaccine misinformation is the most contentious spat yet between the tech giant and the White House. POLITICO’s Alexandra S. Levine checked in with Joan Donovan, research director of the Harvard Shorenstein Center on Media, Politics and Public Policy, to help read between the lines. The conversation was edited for length and clarity.
What’s your impression of the back-and-forth between the White House and Facebook?
It reminds me a lot of the age-old debates around “guns don’t kill people, people kill people.” We’re very much in the consequence phase of years of accumulated misinformation, profiteering by media manipulators, politicians utilizing social media to their political advantage, especially leveraging the scale and the scope of messaging… social media has really accelerated this problem of misinformation at scale.
Where are we now?
We have to address the misinformation question, because we are now at a point where misinformation is motivating people not to take action. … Technology companies are not going to take responsibility for what they have built. This is why you see regulators moving away from Section 230 [the part of the 1996 Communications Decency Act which protects online platforms from liability for content their users post] and into data interoperability and … antitrust.
Social media provides for this massive broadcast capability that is highly regulated if you were to use television or print or radio, but for some reason, because the technology is the internet, ideologically people are wedded to this idea that it is somehow not in the jurisdiction of the government.”
I think the government needs to pay attention to the development of what we might call partisan platforms that have very low standards of content moderation … because some of those platforms we know are being put together and financed in such a way so as to sow division and radicalize people. You have to have a sense of what quality information is being delivered to the public in massive volumes, and then think about that from a regulatory standpoint. Which is to say: where do you place liability in terms of the broadcaster, the individual speaker? I think that part of the conversation really needs an overhaul, rather than focus on misinformation as a very particular domain.
The other part of the question is really about how do we imagine ‘incitement’? Both after January 6, but also, what is incitement when you have an anti-vaccination movement that utilizes social media platforms like Facebook for over a decade to do recruitment? What is that kind of public harm if you’re spreading misinformation? … The problem is a lot bigger than just the tech part of it. But it’s not something we should ignore.
THE COST OF COMPLIANCE: The Biden administration wants to boost the fines that hospitals face for hiding pricing data, heeding the advice of researchers who believe it may take a big hammer to curb abuses of market power, POLITICO’s Ben Leonard writes.
The Centers for Medicare & Medicaid Services this week proposed raising the maximum annual penalty for not complying with a Trump-era price transparency mandate from $109,500 to $2 million per hospital, citing reports that many facilities aren’t complying. CMS said there is a “wide variation in prices” for consumers even within hospitals and systems depending on deals cut with insurers. The thinking goes that getting more digestible information in patients’ hands will empower them to make smarter decisions on cost, potentially driving down health spending.
But hospitals still have to play ball. And they’ve been highly protective of the “chargemasters” that list billable items and services that often determine what insurers and patients pay. A study of 100 randomly selected hospitals published in JAMA Internal Medicine in June found that 83 of the hospitals failed to comply with at least one major federal requirement — and that the repercussions of disclosing privately negotiated rates hospitals struck with insurers could outweigh the federal penalties.
Hospitals, who lost a last-minute court battle to overturn the policy, said the requirements were burdensome.
TRACKING THE TRACKERS: A California state lawmaker’s legislative maneuver has revived a privacy proposal that could set new standards for regulating smart health devices and trackers, POLITICO’s Susannah Luthi writes.
Assemblymember Edwin Chau is trying to safeguard personal data collected in smart health devices with the same privacy protections California grants for information gathered in medical settings. The effort would apply to popular fitness and fertility trackers and is drawing fierce opposition from tech industry groups and medical device makers.
Chau’s first bid this year to regulate smart health devices never made it to the Assembly floor for a full vote. Last month, before a key legislative deadline, he reintroduced identical language using the bill number of an unrelated privacy measure that had sailed through the Assembly in April. The amended measure would still need to return to the Assembly floor for a full vote if it gets through the Senate.
Past efforts to police health trackers have gained traction in the state. Former Attorney General and current Biden health secretary Xavier Becerra last year fined the makers of the fertility app Glow $250,000 for failing to adequately protect consumer data.
How closely have you followed recent health-tech headlines? (Answers below)
1) A House spending plan would target this much for President Joe Biden’s new biomedical research agency ARPA-H — a total less than half of what the White House requested:
A) $30 million. B) $300 million. C) $3 billion. D) $30 billion.
2) Telehealth use has stabilized at levels this much higher than before the pandemic, according to McKinsey:
A) 5. B) 15. C) 27. D) 38.
3) This travel industry can, for now, go ahead with plans to use Covid vaccine credentials to verify if passengers were immunized:
A) Cruise lines. B) Airlines. C) Passenger railroads. D) Buses.
4) A Dutch watchdog group says Covid vaccine producer Moderna is intentionally operating out of these two places to avoid paying high taxes on sales of its shots:
A) Puerto Rico and the Channel Islands. B) Switzerland and Delaware. C) Ireland and the Bahamas. D) India and Florida.
5) A new surgeon general’s report terms this an “urgent threat to public health”:
A) Refusing to wear masks. B) Mixing two kinds of Covid shots. C) Vaccine misinformation on social media. D) Cyberattacks on hospitals.
Did dueling death and case models at the beginning of the pandemic erode trust, asks the Minneapolis Star-Tribute.
Will cyberattacks between states and rogue actors become the new normal, ponders the New York Times.
And: does the growing length of clinical notes presage greater burnout among physicians, asks EHRIntelligence.
Answers to Pop Quiz: 1) C. 2) D. 3) A. 4) B. 5) C.