It's personal for Tammy Duckworth

The ideas and innovators shaping health care

Oct 05, 2022 View in browser   By Ruth Reader, Ben Leonard and Carmen Paun Sen. Tammy Duckworth | Francis Chung/E&E News WASHINGTON WATCH Protections for people with disabilities haven't kept pace with the digital age, especially when it comes to ensuring online accessibility and ease of use for devices. It's a personal issue for Sen. Tammy Duckworth (D-Ill.), who lost both her legs in Iraq when her Army helicopter was shot down in 2004. She and Rep. John Sarbanes (D-Md.) have new legislation that would require the Justice Department to issue regulations spelling out websites' responsibility to comply with the Americans with Disabilities Act. The 32-year-old ADA was written before websites existed and whether it covers them is being debated in states as courts have dismissed website accessibility claims. That gray area extends to software, hardware and web-enabled devices, which now include everything from thermostats to tractors. Duckworth's bill would also explicitly require software and app developers to design accessible products for people with disabilities. Ruth spoke with Duckworth about why the senator believes all technology needs to be accessible and what the barriers are. The interview has been edited for length and clarity. Can you tell me a little bit about the timing of the bill? Why now? During Covid, I was trying to get to the CDC websites. I was trying to get to various other websites to get information, and it was hard enough to navigate for someone who's not visually impaired or cognitively impaired. And so it really was an impetus for me. How have your personal experiences influenced the crafting of this bill? I just remember being at Walter Reed [National Military Medical Center] 17 years ago when I was recovering, and one of the guys that I recovered with lost his vision. After we went from flip phones to the iPhone, he couldn't use his phone anymore because he couldn't work the touchscreen. Firsthand, I saw the struggles of those within the disability community. What are the biggest barriers to ADA compliance? Money? I do think that a lot of places just don't want to spend the money to retrofit their websites and applications. But if you build an ADA-compliant website to begin with, you don't have to retrofit them. It doesn't cost you any more money. This is a problem for federal websites as well. Does that concern you? I want to make sure that there's a clear, enforceable accessibility standard. My bill would also establish a technical assistance center and an advisory committee that's going to help folks make the websites accessible and to help the appropriate federal entities. SIGNS OF INTEREST: The Senate Aging Committee is conducting oversight on the accessibility of federal websites and technology. In June, Chair Bob Casey (D-Pa.) and ranking member Tim Scott (R-S.C.), along with other lawmakers, wrote to Veterans Affairs Secretary Denis McDonough and Attorney General Merrick Garland to pressure them to get more involved. WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care. Drones will soon be dropping medications off to patients in Salt Lake City. Talk about airborne immune support! I wonder whether they have to go through TSA? Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com or Carmen at cpaun@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today in our Pulse Check podcast , Lauren Gardner and Shawn Zeller on the nurse shortage and whether the crunch is easing. Plus, David Markowitz on his study about how doctors' notes reveal the way physicians sometimes treat patients differently depending on their ethnicity or gender. Listen to today's Pulse Check podcast. FOLLOW THE MONEY REUTERS Investment in digital health firms offering everything from telehealth appointments to artificial-intelligence software continues to fall in 2022, according to a new report from research firm and seed fund Rock Health. But analysts think the bottom may be close and an upturn on the way. The reason for optimism: Venture capitalists are sitting on hundreds of billions of dollars in cash they've raised but haven't yet invested. Health tech venture spending exploded to record highs amid the pandemic, with nearly $30 billion invested in 2021, up from $8.1 billion in 2019, according to Rock Health. The pandemic brought digital health more into the mainstream as patients adopted virtual care at staggering levels. But funding has fallen in 2022, prompting analysts to speculate that a digital health bubble is bursting or that the market is correcting. Funding dipped most recently from $4.2 billion in the second quarter to $2.2 billion in the third. "Given the year's choppy venture waters and public market correction, investors are holding back from the market, waiting to strike once things stabilize," Rock Health analysts wrote. Here's what investors are thinking about, according to Rock Health: The market for initial public offerings is set for a rebound as soon as this fall. That could boost investments in well-established, private firms that are close to going public. Dry powder is accumulating. That's the money investment firms have raised but not yet deployed. Pressure to find targets is growing. Technology aimed at easing workloads is the top value proposition so far in 2022 after coming seventh in 2021, signaling that addressing burnout is a priority. Telehealth is a crowded market and concerns about overprescribing of certain medicines have left investors skeptical. Still, firms developing virtual and augmented reality software are gaining momentum. THE REGULATORS Artificial intelligence may bring big upsides to health care by improving diagnoses and targeting cures. But it looks increasingly likely that it will have to win the approval of government regulators concerned about poor data quality and "automation bias" by overrelying on computers. The watchdog arm of Congress, the Government Accountability Office, is the latest to say as much. The FDA announced last week it was stepping up its review of software it considers within its regulatory purview, such as algorithms used to identify patients who misuse opioids or are at risk of a heart attack. That set off a debate in industry about whether regulation is needed or will curtail innovation. Now the GAO is out with a report that says policymakers should consider rules for evaluating artificial intelligence as a diagnostic tool. Regulations' pros and cons: The GAO argues stricter rules could help: Pinpoint how well algorithms work under diverse conditions and identify biases and areas for improvement Increase doctors' trust in the technology Focus regulators on where stricter rules are needed and where a laissez-faire approach won't cause harm But GAO says there are potential downsides, too. Regulation will likely: Delay AI's use in the health care field Cost developers money, which will slow or even curtail innovation What's at stake: GAO said AI offers hope for "earlier detection of diseases; more consistent analysis of medical data; and increased access to care, particularly for underserved populations." THINK FAST Patients addressed women doctors by their first names rather than their formal title twice as often as they did male doctors, according to a study published in JAMA Network Open this week. The authors argued that slight "may have a negative impact on physicians, demonstrate lack of respect, and can lead to reduction in formality of the physician-patient relationship or workplace."   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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