ONC speaks out candidly: One of the clear themes of this year’s HIMSS conference clearly seems to be the federal administration’s public push toward a free market healthcare in which the patient is empowered through greater interoperability and access, as well as removing government burdens. To this end, this morning at an ONC press briefing, National Coordinator Donald Rucker, M.D. and John Fleming, M.D., deputy assistant secretary for health technology reform, had several points to make.
Rucker said that while everyone talks about the rise of healthcare costs, it’s important not to forget that the “entire rise in healthcare costs was started when Medicare began in 1965.” He added, “We can go back to having patients shop for their care. That’s the goal— to empower patients in a market economy, [have them] shop for care, and have competition.”
Fleming, meanwhile, who was in Congress during the time when Obamacare was debated most, said that half of America sees the solution to healthcare’s issues as more government control and more regulations, while the other half sees the solution as having a consumer-oriented system. “I think the solution is somewhere in between the two, and we need to solve that,” Fleming said. “Since 1965, the person receiving the care has not been the one who was shopping for it…We have to re-engage the consumer and we need to make pricing and value transparent,” adding that there is currently a lack of transparency since bills sent out by doctors “have no correlation to the care that was provided.” But that is not the providers’ fault; it’s the system’s, which has added on layers and layers of regulations, he said.
Rucker said the idea that patients aren’t ready to understand their data is “nonsense.” Interestingly, however, we asked UPMC’s Chief Innovation Officer Rasu Shrestha, M.D., about this very subject since he is well-versed on both the physician and technology fronts, and he said that while patient empowerment is a nice phrase, and patients are certainly more engaged than ever before, “We need some more substance behind it.” Shrestha added, “You can’t just ‘free the data’ and say, Patient X, here is your data, because they might not know what to do with it. So we need to make sure we empower the patients, but also empower them by giving them the right set of tools, insights and guidance.”
Shrestha, who is also the executive vice president at UPMC Enterprises, said part of the solution is to “shift from paternalistic medicine to intelligent, active participatory medicine, and it’s not just about the doctor-patient relationship, but about the care collaborative, where the patient is leaning in, empowered, and engaged, and you have the entire care team working to improve outcomes and better satisfaction.” That, said Shrestha, is the whole paradigm behind value-based care.
Regardless of what side of the healthcare fence one might be on, for journalists, it was refreshing to hear the federal health IT leaders speak so openly about these issues. You can read Rajiv Leventhal’s full report on the ONC press briefing right here, but there are a few more noteworthy nuggets from the meeting that didn’t make it into the story:
---There has been lots of talk on using APIs (application programming interfaces) “without special effort,” a term that originated in the 21st Century Cures Act. Jon White, M.D., deputy national coordinator for health IT, spoke to the fact that even CMS Administrator Seema Verma (who White says is not your most technically-savant person and will admit as much) is talking about APIs. And what’s even more telling, said White, is that Congress is putting APIs into law. “It comes down to persistent questioning about ‘why can’t I get my data and move it back and forth?’” said White. Shrestha, when asked about open APIs, added, "Yes, they are very important. Any vendor that sells you their ‘wares’ without an API-driven methodology to connect to their wares is shortchanging you.”
---On interoperability, Rucker said that a lot of it today involves “high-priced providers,” but “getting Ford and Chevy connected is as important as getting the Rolls-Royces and Bentleys connected.” Fleming added that “Epic has been good at having its own internal system, but that doesn’t [necessarily] help others—unless we make it ‘Epic for everyone,’ and that doesn’t make sense. A downside to a highly-controlled system is that it does stifle innovation. You need to balance these things,” he said.
This is where Fleming sees TEFCA (ONC’s Trusted Exchange Framework and Common Agreement) as a workaround. “TEFCA is not a highly-regulated approach at all. It’s trying to build a consensus in the industry and a platform that everyone can communicate through,” he said.
Heard at HIMSS: Rumors are that pretty much every blockchain session this week has been packed to the brim with many at standing-room-only status. Take a look:
An uptick in attendees: Total attendee registration as of this morning is 43,536 (for comparison, the second full conference day of HIMSS17 had 40,803 registered attendees).
More on clinician burden and usability: Reducing the burden that IT puts on doctors is a key priority for ONC right now, as Fleming said that ONC has four workgroups currently devoted to the issue. What’s more, in this piece by Mark Hagland, a HIMSS CMIO roundtable tackled physician dissatisfaction with EHRs. John Halamka, M.D., CIO of Boston’s Beth Israel Deaconess Medical Center, led the dialogue, and noted that Eric Schmidt “stole his thunder” on Monday when he said that a digital assistant transcribing the patient encounter should be the future of documentation.
Perhaps the most telling tidbit from the roundtable was Michael I. Hodgkins, M.D., vice president and CMIO at the American Medical Association (AMA), reporting that an AMA-led study of leading hospital CEOs revealed that a burned-out physician costs hospitals between $500,000 and $750,000 a year, in terms of replacement costs, lost productivity, etc.
To this end, Fleming said right now the focus is on reaching out to stakeholders and gathering data on their biggest pain points with IT—as well as understanding what clinicians’ priorities are. The early feedback, Fleming said in a one-on-one with Healthcare Informatics (which will be posted tomorrow), is that documentation guidelines are the biggest issue. The result of all this will be a report that Fleming and co. will send to Congress with recommendations on how to reduce the burden.