Reports of the fax machine’s death are greatly exaggerated

The collision of health care and technology.

Apr 27, 2022 View in browser   By Ben Leonard The Big Idea Micky Tripathi, the national coordinator for Health IT, spoke with Future Pulse about the challenges ahead for integrating more technology into the U.S. health care system without sacrificing patients' privacy. | Office of the National Coordinator for Health IT Micky Tripathi serves as the national coordinator for Health IT at the Department of Health and Human Services, where he's tasked with leading his agency's strategy for increased data sharing by health care organizations.  In a wide-ranging interview, Tripathi spoke to Future Pulse about data sharing, artificial intelligence and the future of the fax machine in health care settings. The interview is edited for length and clarity. There's a lot of talk about data sharing in health care, but what's the big-picture goal?  I don't think there's an end goal, but certainly, there are some thresholds that we want to be able to accomplish. Being able to have an open architecture kind of system where patients are able to access their information for the purposes that they want to be able to access it. And, equally important, where providers and other stakeholders involved in their care are able to appropriately access that information to be able to deliver better health care. You've said privacy is among one of the biggest tech challenges in health care. What are the challenges?   One of the challenges where privacy is a concern is that as more and more information flows out of entities regulated by HIPAA (like doctors) into the hands of patients themselves — which is of course something we want — the data is not protected by HIPAA once it's in patients' hands. Then there's relatively thin privacy protections. That's a challenge for all of us. Because we certainly don't want people to find that their data has been used or exposed in ways that they didn't expect. How can artificial intelligence be used the most responsibly going forward?  There are huge opportunities for appropriate use of AI in health care, from being able to help patients ensure they're going to get better care to providers to allow them to spend more of their time applying human judgment. We do a lot of paper shuffling right now and shifting of forms from here to there to there to there to there, but there's a lot that can be applied, a lot of analytic power that could be applied, that would allow a much more tailored experience for patients in a way that's both more convenient to them as well as providing better and more efficient care. The challenges for us now are that it's still very early and there's a lot of black box-edness to the world of algorithms. Clinicians on the front line don't know exactly why it's delivering these results to me and making these suggestions to me. So they're appropriately concerned and cautious about it. When do you think the fax machine is going to be out of health care?  It's going to be a long time, because these technologies have long tails. If you look at the history of the phone system, we started having modern switching technology in the early 1900s. The last party line system was taken down in the 1970s. That's one aspect. I think the other aspect is that faxing is still highly usable in lots of ways. That's the challenge for us: How do we get to our other forms of technology to be able to mimic the convenience and the flexibility of faxing? That's what's going to allow the replacement of it. In terms of tech, how far behind other sectors is health care? In some ways, you can look at certain areas and say it's really behind. You hear it all the time; people are like, "There's no other place in the world that asks me to fax something, but my doctor's office just did." But it really does depend on how we measure it. We also have higher expectations in health care than we do in other places for good reasons. We don't expect Lowe's and Home Depot to share customer data. We are asking competitors here to share data. That's a higher expectation, that's an appropriate expectation, and they should absolutely do it. So we need to calibrate everything on those lines as well. Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback at bleonard@politico.com or @_BenLeonard_ .    INTRODUCING DIGITAL FUTURE DAILY - OUR TECHNOLOGY NEWSLETTER, RE-IMAGINED:  Technology is always evolving, and our new tech-obsessed newsletter is too! Digital Future Daily unlocks the most important stories determining the future of technology, from Washington to Silicon Valley and innovation power centers around the world. Readers get an in-depth look at how the next wave of tech will reshape civic and political life, including activism, fundraising, lobbying and legislating. Go inside the minds of the biggest tech players, policymakers and regulators to learn how their decisions affect our lives. Don't miss out, subscribe today.     Tweet of the Week Blake Madden @B_Madden4: "Dang yall, I'm gonna be honest. It's depressing seeing these publicly traded digital health names get plowed into the ground by market conditions. It's just a sea of red, even for those executing on their strategy. I hope things turn around soon." Around the Nation MUSK AND HEALTH INFO — Tesla CEO Elon Musk's agreement to buy Twitter and his push for "free speech" on the platform are raising concerns among some experts that potential new, loosened moderation policies could exacerbate health misinformation. Musk hasn't proposed any specific policies related to health information on Twitter, but he defined free speech Tuesday as "that which matches the law" and has been critical of Twitter for not allowing a full range of views. He has been critical of public health restrictions but supports vaccines, tweeting last year that "the science is unequivocal." Elon Musk defined free speech Tuesday as "that which matches the law." | Patrick Pleul/Pool Photo via AP, File Misinformation experts feared any rollbacks of Twitter's health-information policies could facilitate misinformation's spread. "I do think health-related misinformation and disinformation in future public health emergencies are going to continue to be big problems, so going in the opposite direction won't be helpful," said Tara Kirk Sell, senior scholar at the Johns Hopkins Center for Health Security. "It would not be a victory for free speech to give QAnon conspiracy theorists, misguided anti-vax activists and click-bait quack doctors a forum to undermine public health policies that save lives," said Paul Barrett, deputy director of the NYU Stern Center for Business and Human Rights. ABORTION PILL INFO GAP — If the Supreme Court should strike down Roe v. Wade in the coming months, mail-order abortion pills could be a way for millions to terminate their pregnancies discreetly, but most patients are misinformed or in the dark about the pills, POLITICO's Alice Miranda Ollstein reports. Advocacy groups are focusing on disseminating educational, legal and medical information on the pills as groups on both sides of the abortion debate expect Roe to be limited or overturned this summer. "There are so many people who don't know that mifepristone even exists," said Ushma Upadhyay, an associate professor and Ob-Gyn at the University of California at San Francisco who is leading a study on the use of abortion pills in 20 states. "They still picture a dramatic surgical procedure when they think about abortion." Advocates say the new availability of FDA-approved abortion pills that can be mailed to patients' homes could prevent a return to the pre-Roe era when back-alley surgeries, herbal concoctions and coat hangers were among the only options.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Washington Watch TELEHEALTH FINANCIAL CONSIDERATIONS — The Committee for a Responsible Federal Budget has released a new report urging that the potential costs of expanding telehealth access be "taken seriously." The nonpartisan think tank that calls itself a "voice for fiscal responsibility" pointed to the Congressional Budget Office's recent estimate that the five-month telehealth extension signed into law last month will cost $663 million. They argue permanent expansion could cost $25 billion over a decade, and expanding telehealth would "ideally occur only" under value-based payment approaches that could "maximize the opportunities of telehealth without substantially increasing spending." "Because telehealth as a mode of care is here to stay, the argument that authorities need to be made permanent in order to convince providers to invest in technology is not convincing," the report said. "Instead, the occasional expiration of authorities will provide policymakers the opportunity to review research into telehealth's impact on health care costs." Around the World EU DATA SHARING THREATENED — Red tape from the European Commission is threatening its ambitious plan to bolster sharing of the bloc's highly valuable health data, POLITICO Europe's Ashleigh Furlong reports. The plan aims to make sharing data to develop new treatments easier. But as the commission prepares to present its strategy on May 3, some are concerned the proposal could overcentralize decision-making in Brussels and put a hefty compliance burden on nations. POLITICO spoke to people working on those projects in several countries. While hopeful that the commission's legislative proposal would be beneficial, they expressed fears that Brussels would impose a one-size-fits-all bureaucracy that could make their work harder instead of easier. What We're Clicking Several new efforts are being made to bring robots and other tech to nursing homes, The New York Times' John Leland reports. It's "almost impossible" to figure out what Covid variant you had, Bloomberg's Kristen V Brown reports. Farmworkers shouldn't be left out of the virtual care discussion, Nadia Bey of the Duke-Margolis Center for Health Policy writes in Health Affairs.   Follow us

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