Notification of Enforcement Discretion for telehealth remote communications | Hacker News Reader

Notification of Enforcement Discretion for telehealth remote communications

hhs.gov

56 pointssiculars43 comments

I wonder if this change would be a net win for U.S. healthcare:

- Healthcare regulations (HIPPA, insurance coverage, etc.) are updated to make this the new normal.

- Each household is supplied with a decent-quality thermometer, BP cuff, and camera-enabled ear/eye/throat scope. I.e., only 1 step down in quality from what physicians have in the offices. Rudimentary training is given to any interested adult for using these, under the supervision of a physician.

- When someone gets sick, they schedule a Skype-like call with their doctor's office. During that call, the doctor/nurse guides someone else in the household to use those devices as appropriate to gather the data. Based on those results and interviewing the patient, the doctor then provides guidance, and perhaps sends a prescription to the pharmacy / blood lab, and/or asks the patient to come to the office for a more thorough exam.

I would imagine that benefits everyone involved, and perhaps reduces the risk of infections spread at the doctor's office.

The majority of my GP visits over the course of my life thus far could have been carried out this way.

We really aren’t making full use of the technology we have

> Each household is supplied with a decent-quality thermometer, BP cuff, and camera-enabled ear/eye/throat scope.

I think you’re overestimating the capabilities of most people to follow instructions.

... video conferencing doesn’t work at the best of times with IT worker meetings. Good luck with the general populace

> ... video conferencing doesn’t work at the best of times with IT worker meetings.

As recently as three years ago I would have agreed, but video chat is now quite reliable in my experience.

In general I agree but every video chat platform requires a stable and relatively fast / low latency internet connection to be be stable. On lower end hardware the encoding of some platforms is also an issue.

I suspect without other changes a switch to this as a default means of getting initial care or appointments might negatively impact people that are already disenfranchised.

That's where they can drive to a Telehealth clinic. They are very useful in other situations where a patient nerds to see a specialist but cannot travel.

Meanwhile, the internet isn't even considered a utility. Which is especially absurd, in light of recent events.

> They are very useful in other situations where a patient nerds to see a specialist ...

That's a fabulous Freudian slip!

I agree -- while some of us have been fussing with WebEx in the corporate world for years, Zoom seems to have sneaked in from the ease-of-use, small market position. It's working great for my kid's school that has zero dedicated IT workers.

My experience is that WebEx is far behind FaceTime and Skype in terms of reliability and ease of use. So the failures of videoconferencing in the corporate IT context are IMHO self inflicted.

The biggest obstacle is people are lazy according to telehealth nurses

In what way would laziness come into play for telehealth?

People will not actually spend the three minutes to do it everyday. Even people with serious medical conditions skip it most days until a nurse calls to prod them to. This is according to telehealth and inhome care nurses.

There would still be a $250 bill for a 4 minute video call...

And I bet the physician would have 5 calls going on at once too...

Multiple calls are not realistic. You just can't do that while keeping track of records, taking notes, taking history, actually doing a consultation. If you want a "is my throat inflamed? Can I get a doctor's note?" you could maybe do a call with a nurse in 5min. But that probably the minimum possible.

If you have ever used telehealth, it is almost always cheaper than a physical doctor's visit. My provider is only $45 or so for the standard 15-or-so minute call.

Mine is usually about the same price, except right now during the COVID-19 outbreak it is completely free.

You don't need a video conference. Phone call is perfectly fine. I have a telehealth system for heart failure. It works quite well. If my numbers slide over a few days I will definitely be contacted. If it is an abrupt change in readings I will be contacted immediately. Sometimes it really is a misread which is now generally ignored for my circumstances because the person checking my readings have become familiar. For instance if my BP shows 99/60 one day and drops to 40/40 it will be ignored. If it drops to the 70 range I will get a call.

The system is incredibly easy to do but many people simply don't put the minimal effort in. I have one + a cardiomem and it takes me less than three minutes in the morning. The system works well and could be widely adapted for less serious conditions if people were not so lazy

This is a relief! For the last 2 weeks I've been scrambling to kludge together Zoom for Healthcare and Skype for Business meetings for 90 clinicians/social workers at my agency so they can keep seeing clients and bill services.

What's your plan now, given this news?

This will save a lot of lives. It will simultaneously increase the capacity of our health system while also significantly decreasing exposure risk.

I posted this https://news.ycombinator.com/item?id=22601270 as an Ask HN couple days ago but since this thread has more traction, I wonder if I can get your input here. The text:

Ask HN: My mom is a pediatrician. Best temporary remote consultation ideas?

Due to coronavirus my mom wants to avoid kids and their parents coming to her office. The current situation is hopefully temporary, so I don't want to commit to a long term product. Her consultations are usually 20 minutes, sometimes longer. She obviously won't be able to diagnose a lot of conditions without being close and in contact with her patients, but I believe a lot can still be done remotely. For some children, she might have to give prescriptions, which she currently does on a piece of paper only.

She has a secretary that can help juggling the video conferences.

Any ideas how she can handle her daily work?

Here's my current approach:

- 2 links that open distinct Zoom calls

- Secretary calls patient, somehow asks them to load a webpage (a short url service or sms or email)

- Patient joins one of the links, consultation starts

- Meanwhile, secretary calls next patient, asks them to load second link and wait

- Once the first consultation is over, my mom joins the second link one, and secretary is calling for the next patient in line

- Prescriptions are written and either mailed or parents can pick up at her office (maybe on a plastic bag?)

I use Zoom at work but I know how to setup things. Her clients would probably rely on their mobile apps. If it matters, she's from Brazil and we need clients localized to pt-BR.

Thanks for any insights!

What about people that need help to install an app on their phone?

Zoom is probably a reasonable default, but fallbacks to popular consumer stuff might help.

The same thing is happening in the UK, or at least parts of it. I have an appointment coming up, and got a phonecall telling me it would now be done over video link.

The person for very apologetic, but I was like, "Can I have this all the time please?!".

My small regional health insurer here in the US has offered a couple different remote appointment options for several years now. It doesn't replace regular checkups, but it is very convenient when traveling, or for minor concerns.

Seems like the prudent thing to do, to remove any barriers to the access of health care.

Translation: we are weakening HIPPA privacy protections because, virus.

Never mind that a “health emergency” should not really be uncharted territory for a healthcare system, but that’s America for you.

In some cases, this is just allowing providers to use the same software for telehealth, but now without paying extra for the edition that's certified as HIPAA compliant. Eg. Google's G Suite products don't function any differently if your organization signs a Business Associate Agreement with Google. So as long as healthcare providers are still careful, there doesn't have to be any weakening of privacy, just a reduction in red tape and a (temporary) destruction of the market for overpriced specialty telehealth software services.

There is a deep lesson here about HIPAA in general.

It doesn't work any different for the clients, but it may have different features enabled on the backend. For example Google does live transcribing of the conversation on meet/hangouts. Where does it end up with/without hipaa may be significant.

> For example Google does live transcribing of the conversation on meet/hangouts.

Can you provide a link to this? I was unaware of it and can't find the feature. I did find that Hangouts Meet offers video recording...

Hangouts Meet lets you turn on closed captions that are generated on the fly. I'm not aware of any way to save that transcription, so I don't see how it's a privacy concern.

That's the distinction I mean though: You don't see a way to save it, but it doesn't mean Google doesn't keep the record. What prevents that from happening on calls on amounts which didn't sign HIPAA contracts?

> You don't see a way to save it, but it doesn't mean Google doesn't keep the record. What prevents that from happening on calls on amounts which didn't sign HIPAA contracts?

Google's regular G Suite already has terms of service and a privacy policy that appear to me to rule out any obviously HIPAA-violating use of data. If they collect anything from Hangouts Meet, the terms are clear that you still own the data and Google can only use it as necessary to provide the service to you. Absent any evidence to the contrary, it seems reasonable to take Google's legal documents at face value and conclude that there's no functional difference for G Suite core services whether or not you sign a HIPAA agreement with them. It certainly strains credulity to suggest that Google would offer stronger privacy guarantees to HIPAA covered entities than to ordinary enterprise customers, and not even advertise as such.

It's fine to say you don't trust Google. It's not reasonable to insinuate that they violate their published terms of service and privacy policies. It's absurd to suggest that the extra penalties associated with HIPAA would be the deciding factor for them to refrain from committing those crimes only against that narrow slice of their customers.

It's not only the company violations that we need to worry about. "provide a service" can mean different things. Are phrases where the transcription wasn't clear sent to people for verification and training? Are transcriptions saved for unsupervised learning? Even if they're not shared with third parties explicitly, what happens when the company itself is breached?

That's exactly what they're doing, and they're doing it to save lives. We make many decisions during a crisis that would not make sense otherwise.

Without defending any aspects of the US response -- there are a lot that are indefensible -- this health emergency has been uncharted territory for many countries with a variety of approaches to healthcare.

Glad they noted not to perform telehealth over TikTok.

Google would be better, but I don't think I would accept a solution provided by them. I think it would be prudent to invest in independent systems here.

I'm not finding much to laugh about these days, but this made me laugh -- thanks.

It's amazing how much regulation has to be set aside to deal with the pandemic.

It's amazing how much regulation is there that should have never been. And there still is so much more remaining.

What else are technocrats and bureaucracies to do? They've been on a hiring spree for decades. Apparently at the expense of manufacturing and efficiency.

The internet is still not considered a utility in the US. So, it's not just regulation that blocks progress, many times it's lack of regulation.

There are a lot of people in the US still without reliable internet. Thanks to a lack of basic regulations on an essential utility.

Being a utility doesn't make something HIPAA compliant. And being a utility doesn't make it any more accessible. There are millions in the US who do not count water and sewer among their utilities.

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