Last quarter, the Department of Health and Human Services and the Department of Veterans Affairs have both continued to seek public and private partnerships and investigate new technology. Despite controversy over the firing of former VA Secretary Dr. David J. Shulkin, and external criticism from former Vice President Joe Biden toward the Trump administration for taking too long with interoperability roadblocks, there still seems to be a push for new innovation in both departments.
Read on for digital health-related HHS and VA news from Q1 2018. For a list of FDA clearances, be sure read MobiHealthNews' Q1 2018 FDA news roundup.
This quarter HHS started out by clearing up a few points of confusion. After some misunderstandings about a Survey & Certification Letter, the organization has reaffirmed CMS’ stance on texting patient information, specifying that messages sent among clinicians are permissible so long as healthcare teams use a secure platform. Texting patient orders, however, is still prohibited across all platforms.
CMS’ clarification comes shortly after a December 18th report from the Health Care Compliance Association (HCCA) that raised concerns about the center’s policy. The policy outlined in Thursday’s letter now mirrors the current position of the Joint Commission, which underwent its own series of flip-flops on the subject in 2016.
While innovative new ways to treat and connect with patients, like texting among clinicians, are on the rise, the government continues to seek out new approaches to healthcare. In fact, the Agency for Healthcare Research and Quality (AHRQ) at HHS announced that will be conducting a challenge competition this fall focused on developing new tools focused on patient-reported outcome (PRO) data. Specifically, the agency hopes to find user-friendly tools that will better enable collection of the data, as well as its integration into EHRs or other health IT products.
“The patient's perspective is central to healthcare decisions affecting prevention, diagnosis, treatment, and long-term care,” Gopal Khanna, director of the AHRQ, wrote in the notice. “[PROs] critically inform patient-centered outcomes research (PCOR) and can inform clinical management of individuals, shared decision making, patient self-management support, care planning, goal setting and goal attainment.”
HHS has also sought outside help to advise on data projects. In January, Accenture completed its two-year contract with the Office of the National Coordinator for Health IT to create a white paper to advise the industry about implementing patient-generated health data projects.
Emily Mitchell, a senior manager with the Accenture Federal Services Health and Public Service practice and one of the leaders of the project, sat down with MobiHealthNews to talk about the project.
“The white paper, at its most basic, was intended to inform ONC of what are the challenges, what are the best practices, what’s actually going on in the real world as they think about longterm policy considerations,” Mitchell said. “So it was meant to inform the government, help them understand what is the current state and what’s achievable in the future, but also what are the roadblocks that need to be overcome in the meantime.”
But not every department move has been applauded. A new commentary from former Vice President Joe Biden says interoperability roadblocks have been standing for far too long — and that the Trump administration's current plans to fix the problem are insufficient.
Writing for Fortune, Biden alluded to HIMSS18, where Centers for Medicare and Medicaid Services Administrator Seema Verma unveiled the MyHealthEData Initiative, which aims to make patients a lynchpin of data exchange improvements, and where White House Advisor Jared Kushner said President Donald Trump is "is determined to make interoperability a reality for all Americans.”
Biden's take? "Unfortunately, the announcement lacked many specific actions to effectively implement the initiative. I agree with the administration’s stated goals, but real action is needed — and now is the time.”
The VA has joined the bandwagon of government agencies looking for outside innovators to help update its health technology systems.
In February, it became easier for private citizens to become involved when the department launched Lighthouse, an API that allows developers to create digital technology to build mobile and web apps that serve veterans.
With the latest technology on display at HIMSS18, the new API outlines four components for developers: standards-based, data-drive, future-proof and veteran-centric technology.
One example of a public-private partnership for the VA is a research agreement with Alphabet subsidiary DeepMind that will tackle issues concerning patient deterioration during hospital care. Using a dataset comprised of 700,000 historical, de-personalized health records, the machine learning platform will help the VA identify risk factors for deterioration while predicting its onset.
“Medicine is more than treating patients’ problems,” Shulkin said in a statement. “Clinicians need to be able to identify risks to help prevent disease. This collaboration is an opportunity to advance the quality of care for our nation’s veterans by predicting deterioration and applying interventions early.”
The VA is also looking to new technology as a way to solve some key problems. A recent study sponsored by the department applied wearable biosensors to post-acute heart failure patients and deployed FDA-cleared analytics from vendor physIQ to detect vital sign anomalies.
It demonstrated promising predictive power for artificial intelligence-based analytics in terms of sensitivity, specificity and early warning lead time — suggesting the potential to transform to a proactive, personalized care model for at-risk patients, according to investigators from the Utah School of Medicine and the VA Salt Lake City Health Care System.
However, the VA's largest shakeup came at the very end of the quarter when President Donald Trump ousted Shulkin from his leading role at the agency after months of turmoil reports the secretary had fallen from the president’s graces.
The president made the announcement on Twitter, nominated his personal physician Rear Adm. Ronny L. Jackson to replace Shulkin. Robert Wilkie, Department of Defense undersecretary, is serving as acting secretary in the interium. So far, there has no word on if, or when, the VA will sign its planned contract with Cerner to replace the agency’s legacy EHR.