Advocacy Update

• CAP Joins Clinician Roundtable to Discuss Impact of Universal Donors on US Blood Supply
• White House Urges Congress to Fund Strategic National Stockpile for Future Pandemics
• Pathologists Leadership Summit - Join the Virtual Hill Day From Your Home, Laboratory, or Hotel
• Responding to CAP and AMA Advocacy, ONC Broadens Definition of Harm in New Information Blocking FAQ
• Test Your Advocacy News Knowledge
• Breaking Advocacy News: Check out the Advocacy Twitter Channel

Recently a clinician roundtable of the Alliance for a Strong Blood Supply met to review the overuse of the universal blood type O and discuss strategies to increase blood supply nationwide during this ongoing shortage. The CAP, along with 16 other hospital, medical and laboratory groups, are members of the Alliance for a Strong Blood Supply, a coalition of organizations committed to ensuring sufficient blood is available for all patients during the pandemic and beyond. The Association for the Advancement of Blood & Biotherapies (AABB) launched the Alliance to address current challenges with the nation’s blood supply. The CAP advocates for a safe blood supply for patients and communities across the United States.

The group met on March 3 to share best practices aimed at supporting the stewardship of the blood supply. Glenn E. Ramsey, MD, FCAP, Chair of the CAP Transfusion, Apheresis, and Cellular Therapy Committee, represented the CAP at this meeting, where the group discussed the overuse of the universal blood Type O. Type O blood is in high demand during this blood supply shortage as it may be transferred safely to recipients of any ABO Rh(D) type. However, this overuse of the universal donor O blood could lead to critical shortages, limiting the supply for patients who need it.

The group discussed the following recommendations to ensure appropriate blood type O use:

1. Group O should be reserved for three cohorts of females of childbearing potential: those who are group O Rh(D)-negative, those who are Rh(D)-negative requiring transfusion when type-specific blood is unavailable, and those of unknown blood type who require red blood cell (RBC)s before the completion of pretransfusion testing.
2. Hospital transfusion services should closely monitor with the current use of Rh(D)-negative inventory blood supply. Hospitals should develop policies now that describe when patients should be switched to Rh(D)-positive RBCs to avoid depletion of the group O Rh(D)-negative supply.
3. Hospitals should have protocols to expedite sample collection to quickly switch patients to type-specific blood upon completion of pretransfusion testing.

Regions throughout the United States are currently facing significant blood supply challenges, with many blood collectors operating with less than a one-day supply on hand, which is below the ideal goal of at least a three-day supply. As a result, hospitals have been forced to delay life-saving blood transfusions and postpone nonessential surgeries.

On March 2, the Biden Administration announced it added personal protective equipment and diagnostic tests to the Strategic National Stockpile of medical equipment and further asked Congress for related funding. In its COVID-19 response strategy report, the Administration added at-home COVID-19 tests, antivirals, and masks to the Strategic National Stockpile, but needs additional funds from Congress to increase domestic vaccine and virus test manufacturing. The CAP has encouraged the Biden Administration to prepare for future public health emergencies, including shoring up the strategic national stockpile supply chains, global and domestic vaccine manufacturing, biosecurity, and therapeutics.

The administration has sought to invest in sustained manufacturing of COVID-19 tests and vaccines that can be stockpiled in preparation for future pandemics. The funding request to Congress for scaling up domestic vaccine and test manufacturing. The Administration will also take steps to ensure that the medical device industry can rapidly scale up manufacturing capacity if needed. However, the report does not detail how many at-home tests the government hopes to put in reserve.

The Pathologists Leadership Summit on April 30 – May 3, will now have a completely virtual Hill Day for pathologists to meet with their elected members of Congress. Due to restrictions placed on visitors accessing congressional office buildings, the Hill Day meetings on Tuesday, May 3 will be virtual. Regardless of whether you attend in person or virtually, the CAP will help all members prepare and meet with their policymakers through remote or DC-based virtual meetings. Only you can make an impact by educating your members of Congress on the value pathologists deliver in health care and our impact on patient care.

The CAP will serve breakfast and lunch and have meeting space available at the Grand Hyatt in Washington, DC for those that would like to be on-site for their virtual Hill Day meetings. CAP staff will connect you with your fellow CAP members and prepare you for your virtual meetings if you are attending remotely.

The CAP encourages all members attending the Pathologists Leadership Summit to participate in Hill Day, whether you are attending remotely or on-site in Washington, DC. First-time Hill Day participants will be trained prior to the meetings.

Register today

Because the CAP and the American Medical Association asked for a broader definition of potential harm, the National Coordinator for Health Information Technology (ONC) office added new language to account for emotional and psychological harm in the agency’s information blocking regulations. The agency recently released an updated Frequently Asked Question (FAQ) document, which enables physicians to consider whether the patient or another person may suffer “substantial harm,” is defined to include “physical, emotional or psychological harm. ”

The FAQ document further clarified that this expanded definition can be considered when evaluating the release of medical records, or test results, to a patient’s performance representative. However, the FAQ does not include an expanded definition when patients request their records.

The Preventing Harm Exception permits clinicians to deny a request for electronic health information (EHI) under certain circumstances that could lead to harm. Both the CAP and the AMA have urged the ONC for clear guidance regarding the information blocking regulations and consider psychological harm as necessary consideration as other harms.

The Preventing Harm Exception allows physicians to deny on a case-by-case basis a request for EHI if it can lead to patient harm, but depends on:

1. Who is requesting access to a patient’s EHI
2. Who is referenced in the EHI
3. What type of harm may occur

The ONC guidance enables physicians to consider emotional and psychological harm and physical harm when releasing a patient’s medical records to the patient’s representative, which is different when a patient requests their medical records. While the CAP appreciates the expanded definition, there is still a potential for psychological or emotional harm for patients accessing their information.

The CAP will continue to advocate with the ONC to develop exceptions for patients who wish to speak to their doctors before receiving alerts about potentially severe or life-threatening illness.

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