Privacy in telehealth, stress and strokes, update on respiratory viruses, and the impact of COVID vaccines

December 16, 2022

Happy Friday!

Today, I’ll cover disconcerting reports that some telehealth companies are sending sensitive private information to big tech companies, the impact of stress and sense of control on stroke risk, current status of respiratory diseases in the US, and the financial value and lives saved from the COVID-19 vaccinations.

1.     Some telehealth companies send sensitive health information to Facebook and other technology companies

StatNews reported this week that all but one of 50 direct-to-consumer telehealth companies they evaluated were passing along highly sensitive personal data to big technology companies.  The telehealth companies generally consider themselves “platforms” and not health care providers, so contend that they are not technically obligated to abide by the Health Information Privacy and Accountability Act (HIPAA), even though many of them claim to be “HIPAA-compliant.”

Telehealth companies sent health information including such sensitive items as suicidality, illegal drug use and drugs prescribed. This data was often associated with individual identifiers such as name, address, email address, phone number and IP address. While most telehealth companies in this report provide services directly to members of the public, some of them also sell services to employers, and more of them intend to do so.

This comes just weeks after the Wall Street Journal reported that some health care delivery systems were transmitting sensitive personal data to big tech companies including Microsoft, IBM and Amazon. This included data associated with virtual visits with clinicians. Many of these providers reported that they were changing their systems to prevent such data transmission.

The Health and Human Services Office of Civil Rights issued a bulletin last week stating that HIPAA regulated entities are “not permitted to use tracking technologies in a manner that would result in impermissible disclosures of PHI [protected health information] to tracking technology vendors…” Vendors providing health services to employer-sponsored health care members are clearly HIPAA regulated entities, so should abide by this bulletin.

Implications for employers:

-        Current federal regulations protecting patient privacy have substantial loopholes that can allow highly sensitive data to be acquired by third parties.

-        Public scrutiny arising from this reporting can improve vendor behavior even without regulatory intervention.

-        Employers should carefully evaluate the privacy and security capabilities of their vendors, and check with counsel to determine if they need to put a Business Associate Agreement in place with vendors that are dealing with member protected health information.

2.     Higher stress and less sense of control associated with higher risk of strokes

Researchers mined a large international dataset of over 26,000 people who had their first stroke from 2007 to 2015 and found that those who had a stroke were more likely to have reported severe stress in the preceding months. Further, this risk was substantially reduced by those who felt a higher degree of personal control in their work life and in their family life. This study is remarkable for the size of the data set and is relevant to employers as the average age of subjects was 62.

Source: Reddin, et al JAMA Network Open December 9, 2022 LINK

Implications for employers:

-        While no employer can eliminate stress from the workplace, offering employees a greater sense of control can improve their health outcomes, as well as improve work output.

-        Employers that work with vendors that improve cardiovascular risk factors should inquire as to what kind of psychosocial support are part of their programs

-        Employees, or those concerned about their loved ones, under severe stress this holiday season may need immediate support. Employers can advertise the 988 Emotional Distress & Suicide Prevention line (available in English/Spanish)

3. Update on respiratory viruses

The rate of illness from respiratory viruses in the US continues to be very high compared to pre-pandemic seasons. RSV hospitalization rates continue to decline, although they remain twice as high as last fall. Influenza hospitalizations continue to increase, and are the highest they have ever been in mid-December.  Many areas face a shortage of Tamiflu (oseltamivir), an effective oral antiviral with generic availability, although there are other more expensive alternatives available. COVID hospitalization rates continue to climb - although remain substantially lower than they were last year at this time as we entered the first Omicron wave.

Implications for employers:

-        We can continue to expect more time away from work

-        Sick leave encourages sick workers not to come to the workplace.

-        It’s not too late to encourage influenza vaccinations, which are most effective beginning two weeks after vaccination. It’s also a good time to recommend bivalent boosters for COVID-19, which are very effective at preventing hospitalizations and death.

-        Companies should continue to be “mask friendly,” and more employees are likely to want to wear masks especially in crowded spaces. 

-        Maintain good ventilation, especially at holiday parties, where people eat and drink (and thus are much less likely to wear masks)

-        Consider adding a virtual option to larger meetings or events, if appropriate 

4.     US COVID-19 vaccination program saved 3.2 million lives and averted over $1 trillion in medical costs

The Commonwealth Fund has published its most recent estimates of lives and medical costs saved by the US COVID-19 vaccination program. Researchers found that vaccinations prevented 18.5 million additional hospitalizations, 3.2 million additional deaths, and an additional $1.15 trillion in medical costs between December, 2020 and November, 2022. These findings are sensitive to modeling assumptions, and do not include economic impact of time away from work, caretaker burden and replacing those who died or were disabled by illness. They also don’t include the value of vaccinations given outside of the US, which likely decreased the emergence of variants. 

Comparison of Reported COVID-19 Incidence per 100,000 People in the U.S. and the Simulated Scenario Without Vaccination

Implications for employers:

-        Vaccinations against COVID-19 have helped us return to more normal personal and work lives.

-        COVID-19 vaccinations have been paid for by the federal government until now, but unless Congress passes new funding in the next few weeks they will become the responsibility of employer-sponsored health insurance sometime early next year. It’s likely that the unit costs will be much higher if purchased through pharmacy benefit managers rather than by the government.

I’ll likely not be writing posts for the next two weeks – so best wishes for a happy, healthy and joyous holiday season, and a wonderful new year! Please subscribe, and share with friends and colleagues!

Jeff