Health and Human Services (HHS) deputy assistant secretary for health technology reform, John Fleming, M.D., spoke at an event on May 24 where he reaffirmed the government’s two core health IT priorities—better electronic health record (EHR) usability and interoperability.
Dr. Fleming, a former Louisiana Rep. who practices family medicine, was tapped earlier this year to be somewhat of a health IT czar for HHS in a new role that was created for him. Fleming, speaking at the “Better Together Health 2017: All Systems Go! Closing the Gaps in Cancer Care” event yesterday in Washington, D.C., said that his vision for the future of healthcare technology is tied to two core goals: improving the usability of health IT systems and also interoperability, which would be sparked by every American having a single unified health record that resides in the cloud. He noted that federal leaders are “undergoing a re-imagination at HHS,” spending time discussing with staff the innovative ideas they have going forward. I will be giving Sec. [Tom] Price positive feedback,” he said.
Fleming, who spoke publicly for the first time since his appointment at HHS, kicked off his short speech on the progress that’s been made since the creation of the Office of the National Coordinator for Health IT (ONC) years ago. The EHR adoption rate is now at above 85 percent for office-based practices and in the 95 percent rage for U.S. hospitals, he added. “But we cannot rest on that laurel; there’s more work to do,” he said. “If we don’t maintain forward progress, we might see a [decline] in those rates, particularly in ambulatory environments.”
He noted that the next step in clinicians’ EHR journeys is improving usability. He mentioned the well-publicized study from last year that found doctors spend two hours in their EHR for every one hour of patient engagement. “Usability is our immediate, existential problem today. People tell me they only recognize their doctor from the back of his or her neck. We need to change that,” Fleming said.
Interoperability is another growing issue, said Fleming. “Most people [ask] what the big deal is, since we go on the Internet and we’re talking to machines all the time, but in the EHR space you have a number of systems on different platforms speaking different languages. You want detection, early diagnosis and rapid intervention when it comes to cancer, and we want to deliver that for you. We are working with stakeholders to make that happen,” he said.
Fleming, who is a former co-chair of the GOP Doctors Caucus and Freedom Caucus, and was part of a petition last fall to make the MIPS (Merit-Based Incentive Payment System) payment path under MACRA (the Medicare Access and CHIP Reauthorization Act) far less complex for doctors, also touched on alternative payment models during his speech without ever mentioning MIPS. He stated that there was a recognition back in the 1990s that capitated care could be the direction to go towards rather than fee-for-service reimbursement. “If you’re paying for service, you'll get service, whether the outcomes are good or not,” he said. To this end, he asked the question, “How do you pay for outcomes without good data? We need better methods for getting data into the system and delivering it to you, and we’re working on doing that. There is a good marriage between pay-for-value and data,” he said.
Fleming further noted the importance of telemedicine, telling a story in which his daughter sent him an iPhone video of her daughter needing help with a respiratory problem. Fleming said he was able to give his daughter advice, saving her the cost of an ER visit, which he estimated could have cost $2,000 to $3,000. “The iPhone is one of the best methods of telemedicine that I have seen. Where you’re not worried about doing things for reimbursement, you’re doing good things for the patient,” he said.
In the end, Fleming said the core idea is to bring down the time commitment that clinicians and providers spend on using technology. He said the goal is to have them spend less time on data input than they did in the pre-electronic era, and that will save more time in the long run since tasks like calling pharmacies and labs are not needed anymore with EHRs present.
Fleming concluded, “Every American should have a single unified health record that resides in the cloud so that the patient can get his or her information to any provider he or she wishes.” He added that too often still, the discussion amongst doctors is that patients come in with sheets of paper that the clinician can’t read due to note bloat. This results in the doctor turning around and asking the patient what the previous doctor said. “We need to get past that and have a single health record that can be accessed anytime, anywhere in whole world,” he said.