Biden’s chance to supercharge digital health

Future Pulse is a weekly newsletter exploring the rapidly changing world of health care and

Future Pulse is a weekly newsletter exploring the rapidly changing world of health care and technology. We call out fads from real advances, chronicle experimentation and investigate the tension between innovation, regulation and privacy. Join the conversation!

COMMON GROUND: Could health technology provide a thread of continuity between the administrations of Donald Trump and Joe Biden? Will the demands of the pandemic and the pace of innovation just make it too hard to change course?

Biden was a booster of health research as vice president, helping steer passage of the 21st Century Cures Act and launching the precision-medicine-focused cancer moonshot. He could pick up where he left off, even building on the Trump administration’s efforts to free up patient data and embrace virtual care.

But the likelihood of a divided Congress means some other federal efforts — like privacy legislation — may be snuffed out, leaving states with online privacy laws like California to chart their own paths. And some initiatives, like the Department of Veterans Affairs’ $16 billion digital health record transformation, may simply be too big for Biden to change.

Here are four areas that will offer early signs whether we’ll see tinkering or a bigger divergence on health tech:

Covid response: Biden’s pandemic task force features industry heavyweights like Atul Gawande, who previously led Haven and is now chairman of the JPMorgan-Berkshire Hathaway-Amazon health venture. And the president-elect has pledged to hire 100,000 people to assist with contact tracing.

But it’s not clear yet if Biden has a plan to coordinate exposure notification apps built on Apple and Google’s technology that set off warnings if people are exposed to an infected person. Public health officials say the federal government has to step up to encourage more adoption and promote interstate data sharing. It’s increasingly urgent with new cases hitting record highs and the virus engulfing the Upper Midwest and Plains states.The Biden campaign didn’t respond to our queries.

Interoperability: Health tech experts and Obama administration alumni like Deven McGraw, who led health privacy programs at HHS, expect a Biden-Harris administration to continue Trump’s work in easing the flow of health information — with particular focus on Covid-19 data. The Trump administration’s push to let patients download their health records to smartphones stems from data sharing programs established under Obama. But McGraw added “[m]odernization of the public health data infrastructure was not prioritized — I expect that work to escalate significantly.”

Other former Obama administration officials are hoping for a more hands-on approach from the feds. Farzad Mostashari, CEO of startup Aledade, said an incoming administration should push information blocking rules requiring electronic data be made available to patients for free — which the Trump administration has delayed amid the pandemic — and to promote the sharing of patient information within Medicare.

Telehealth: Trump and his Centers for Medicare and Medicaid Services have boosted virtual care by expanding the number of types and telehealth services that Medicare pays for, at least during the pandemic. Telehealth advocates don’t expect that trend to change under Biden, especially given broad bipartisan support. Biden has touted telehealth in his rural health care plan, including a pledge to expand federal grants for virtual care. “There’ll be lots of regulations and things they’ll be trying to undo that folks did, but telehealth is not one of them,” said the American Telemedicine Association’s Kyle Zebley.

Privacy: Trump has been largely absent from the federal data privacy debate, and it’s not clear the Biden administration will be able to push an ambitious national agenda either with what’s shaping up to be a divided Congress. Some states may take the lead.

California voters just approved a ballot proposal that will limit companies’ use of their sensitive personal information— including foot steps, heartbeats, fertility cycles and sleep patterns. The law generally exempts entities that operate under federal health privacy rules, but will in this case apply to direct-to-consumer products and services, including much of the growing wearables market.

“For digital health products that are offered directly to a consumer or a patient, the impact will be enormous,” said Reece Hirsch, co-head of the privacy and cybersecurity practice group at Morgan Lewis. If Californians exercise their rights in large numbers and companies can’t use the data for product development or research, Hirsch said, “That could really stop a digital health company in its tracks.” The new rules, which take effect in 2023, could set a de facto national standard for companies that count any of its 40 million residents as customers.

Alexandra S. Levine contributed.

Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @dariustahir, @ravindranize, @ali_lev, @katymurphy.

Matt @mattripkey “Normal People: decline spam callers/unknown numbers Me: try to sell them EHR integration until they hang up.

‘’You miss 100% of the shots you don’t take. – Wayne Gretzky ‘- Michael Scott’ – Me”

BUILDING NEW CONNECTIONS: Colleges trying to contain the spread of coronavirus are tracking students in unusual ways, to better know where to deploy rapid tests and stamp out potential campus hot spots. But they’re encountering a familiar obstacle: The systems for carrying the data don’t all talk to each other.

The University of Arizona is cross-referencing Wi-Fi access records, which show where students congregate, to the results of wastewater tests that detect traces of the virus in dormitories. Then, if rapid antibody tests turn up positive cases, a notification goes out to the entire residence hall to begin preparations for isolating the student or students, Nirav Merchant, a data scientist at the school, tells POLITICO’s Mohana Ravindranath.

But while the remedy is straightforward, tying all the records together has been frustrating. Unable to automatically pull results from rapid testing machines from campus health records because of incompatible data standards, the school had to build an entirely new data system to cull results directly from the machines. “You need a way to understand how many people have tested, how many people are positive, and take institutional steps,” Merchant says.

QUESTIONS FOR PHYSICIAN-ANGEL INVESTOR IVOR HORN: The pediatrician and former startup executive joined with venture fund Rock Health this week to release a report on diversity in digital health startups. Beyond finding that minorities are generally underrepresented, the survey showed Black, Hispanic and Middle Eastern entrepreneurs were also more likely to “bootstrap,” or build their businesses without access to venture capital; and that people of color were more likely to perceive the state of diversity as getting worse. Horn discussed the findings with POLITICO’s Darius Tahir. The conversation has been edited for length and clarity.

Any surprises in this study?

There’s this common thought that if you have more diverse founders, then you’ll have a more diverse pipeline and a more diverse leadership [managers, directors, VPs of the firms]. We couldn’t connect the leadership to the founder … it made us say, hmm, should we have that assumption? Maybe we shouldn’t. That was one of the surprises.

The second one, when we look at the founders by region, we found many more Black and brown founders from the South and Midwest. When you juxtapose that with the Rock Health database with where funding dollars, investor dollars come from — in the West and Northeast — there’s just clearly not a matchup.

To your last point, I was struck by the statistic that people of color were more likely to bootstrap. Is that because of connections, because of venture capitalists’ approach to what types of companies are worth funding, or something else?

There are a couple things. We always talk about pattern-matching, investors who talk about pattern-matching. But they pattern-match the company they fund into something they comprehend and understand. If they lack the context Black and brown founders do, they can’t quite see how that company can grow and scale, and be a venture-backed company.

That is part of the issue. Black and brown founders are seeing what’s happening in their communities, and they’re building for what’s happening in their communities. The people who are investing, they don’t have that lived experience to understand that these are and can be successful companies.

So these companies, they’re being built and being bootstrapped. With health care, that need for scale is pretty significant. Getting that first funding is always a big jump for Black and brown founders.

WHAT THE FTC’S ZOOM SETTLEMENT COULD MEAN FOR TELEHEALTH: Consumer video chat platforms were nothing short of essential when the pandemic forced more patient visits to go virtual. But the Federal Trade Commission’s new settlement with Zoom over the company’s “deceptive” security practices brought to the forefront the potential risks companies face bringing more health care online.

The FTC complained that Zoom for years misled users, including telehealth patients, about the privacy and security of the technology. A settlement announced Monday forces Zoom to shore up its privacy and security practices, though the commission’s two Democratic members complained Zoom got off too easy, POLITICO’s Leah Nylen writes.

Either way, the settlement “clearly raises the stakes” for health care providers and insurers using Zoom for sensitive conversations, said Wilmer Hale privacy lawyer Kirk Nahra. Zoom in fact offers a separate health-specific software the company says is HIPAA-compliant, but some providers may be using other versions.

Thinking about privacy: Recall that HHS has temporarily relaxed HIPAA enforcement on video chat platforms to encourage more telehealth during the pandemic. That’s led to a debate about what responsibility health systems have to accommodate virtual visits even if there’s not airtight tech security, Nahra said.

Some telehealth proponents have pushed providers to rapidly scale up remote care for the sake of patients’ convenience, but the FTC settlement “might put some pressure on going the other direction,” Nahra said.

As telehealth grows, tech companies may need to bolster their software’s safeguards even if it’s not designed for health care. Companies “absolutely need to be thinking” about broad privacy laws like HIPAA, even if they’re not technically governed by them, Nahra added.

Slate examines the trend of insurers rolling back coverage for telehealth.

Is telehealth expanding access for transgender patients, asks Houston Public Media.

And a coronavirus data analyst in Florida’s government is a conspiracy theorist, reports the Miami Herald.

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